Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
Europace. 2012 Jul;14(7):986-93. doi: 10.1093/europace/eur429. Epub 2012 Feb 2.
To evaluate the clinical implication of right ventricular (RV) to left ventricular (LV) interlead sensed electrical delay (RV-LVs) and the relation to ventricular lead position in cardiac resynchronization therapy (CRT).
Eighty-five consecutive CRT patients (mean age 66 ± 11 years) received LV lead prospectively targeted to the latest mechanical activated segment (concordant), assessed by two-dimensional speckle tracking radial strain (ST-RS) echocardiography. The RV lead was randomized to RV apex (n= 43) or RV high posterior septum (n= 42). Right ventricular to left ventricular interlead sensed electrical delay was obtained during the CRT implant procedure. Intraventricular dyssynchrony was evaluated by ST-RS echocardiography. Interventricular mechanical delay (IVMD) was measured by using pulse-wave Doppler. Separated by the median RV-LVs (82 ms), a long RV-LVs demonstrated more LV end-systolic volume (LVESV) reduction than a short RV-LVs (-27 ± 20 vs. -16 ± 22%; P= 0.02), 6 months after CRT (6FU). Right ventricular to left ventricular interlead sensed electrical delay correlated to IVMD (r = 0.50; P< 0.001) and intraventricular dyssynchrony (r = 0.25; P= 0.02) at baseline. Concordant LV leads (n= 61) demonstrated superior reduction of LVESV (P= 0.005) 6 months after CRT; however, both RV lead positions had similar effects. Right ventricular to left ventricular interlead sensed electrical delay was irrespective to LV lead concordance and RV lead position (P= ns). Independent predictors to reverse remodelling (reduction of LVESV ≥ 15%) at 6FU were concordant LV lead (odds ratio, 3.210; P= 0.029) and IVMD (odds ratio, 1.028; P= 0.026).
Right ventricular to left ventricular interlead sensed electrical delay was not predictive to LV reverse remodelling affected by CRT at 6FU. Concordant LV leads demonstrated superior LV reverse remodelling at 6FU. Right ventricular to left ventricular interlead sensed electrical delay was irrespective of ventricular lead position and might be insufficient to target optimal LV lead position in CRT.
http://clinicaltrials.gov. Unique identifier: NCT01035489.
评估右心室（RV）至左心室（LV）导联间感知电延迟（RV-LV）在心脏再同步治疗（CRT）中的临床意义及其与心室导线位置的关系。
85 例连续 CRT 患者（平均年龄 66±11 岁）前瞻性地将 LV 导线靶向至最晚机械激活节段（一致），通过二维斑点追踪径向应变（ST-RS）超声心动图进行评估。RV 导线随机置于 RV 心尖（n=43）或 RV 高位后间隔（n=42）。在 CRT 植入过程中获得 RV-LV 间感知电延迟。通过 ST-RS 超声心动图评估室内不同步。通过脉冲波多普勒测量室间机械延迟（IVMD）。RV-LV 中位数（82ms）分隔，长 RV-LV 较短 RV-LV 显示更多的 LV 收缩末期容积（LVESV）减少（-27±20 比-16±22%；P=0.02），在 CRT 后 6 个月（6FU）。RV-LV 间感知电延迟与 IVMD（r=0.50；P<0.001）和基线时室内不同步（r=0.25；P=0.02）相关。一致的 LV 导线（n=61）在 CRT 后 6 个月时显示出更好的 LVESV 减少（P=0.005）；然而，两种 RV 导线位置都有类似的效果。RV-LV 间感知电延迟与 LV 导线一致和 RV 导线位置无关（P=ns）。6FU 时逆转重构（LVESV 减少≥15%）的独立预测因子为一致的 LV 导线（优势比，3.210；P=0.029）和 IVMD（优势比，1.028；P=0.026）。
RV-LV 间感知电延迟不能预测 CRT 后 6FU 时的 LV 逆转重构。一致的 LV 导线在 6FU 时显示出更好的 LV 逆转重构。RV-LV 间感知电延迟与心室导线位置无关，可能不足以确定 CRT 中最佳的 LV 导线位置。
