Sideris Skevos, Aggeli Constantina, Poulidakis Emmanouil, Gatzoulis Kostas, Vlaseros Ioannis, Avgeropoulou Katerina, Felekos Ioannis, Sotiropoulos Ilias, Stefanadis Christodoulos, Kallikazaros Ioannis
Cardiology Department, Hippokration Hospital, Athens, Greece.
J Interv Card Electrophysiol. 2012 Oct;35(1):85-91. doi: 10.1007/s10840-012-9681-6. Epub 2012 May 3.
Bifocal pacing in the right ventricle is an option for patients with end-stage heart failure in whom biventricular pacing is not possible, due to failure in left ventricular (LV) lead insertion. The purpose of this prospective study was to document the clinical response of these patients, after bifocal pacing.
From the patients referred for cardiac resynchronization therapy (CRT), from 2009 to 2010, 13 cardiac CRT candidates who underwent unsuccessful LV lead implantation were included. The bifocal system's leads were implanted in the right atrium, the right ventricular (RV) apex, and the RV outflow tract. Initial patient assessment and follow-up evaluation after 6 months included clinical criteria, echocardiographic indices, and biochemical parameters.
From 13 patients (age 68 ± 9 years, nine male), 10 improved clinically. New York Heart Association classification was reduced by one grade (from 3.6 ± 0.5 to 2.8 ± 0.8, p < 0.005 and respectively), while hospitalizations in 6-month time were reduced from three to one (p < 0.001). Six-minute walk test (in meters) increased from 176 ± 86 to 297 ± 91 (p < 0.001) and quality of life improved (EQ-VAS scale changed from 42 ± 12.5 % to 70.8 ± 20.3 %, p < 0.001). Mean shortening in QRS duration was 31.3 ms (from 165.1 ± 16.3 to 133.8 ± 12.7, p < 0.001) and B-type natriuretic peptide (in picograms per milliliter) dropped from 834 ± 350 to 621 ± 283 (p < 0.001). Ejection fraction (in percent) increased from 27.5 ± 4.6 to 33.3 ± 4.4 (p < 0.001), and mitral regurgitation severity decreased by one grade (from 2.7 ± 0.9 to 1.8 ± 0.7, p < 0.05).
RV bifocal pacing seems to offer a substantial clinical benefit to heart failure patients with traditional CRT indications and could be an alternative option when LV access is unsuccessful.
对于因左心室（LV）导线植入失败而无法进行双心室起搏的终末期心力衰竭患者，右心室双焦点起搏是一种选择。这项前瞻性研究的目的是记录这些患者在双焦点起搏后的临床反应。
纳入2009年至2010年因心脏再同步治疗（CRT）转诊的患者中13例左心室导线植入未成功的心脏CRT候选者。双焦点系统的导线植入右心房、右心室（RV）心尖和RV流出道。初始患者评估和6个月后的随访评估包括临床标准、超声心动图指标和生化参数。
13例患者（年龄68±9岁，男性9例）中，10例临床症状改善。纽约心脏协会分级降低一级（从3.6±0.5降至2.8±0.8，p<0.005），6个月内住院次数从3次降至1次（p<0.001）。6分钟步行试验（以米为单位）从176±86增加到297±91（p<0.001），生活质量改善（EQ-VAS量表从42±12.5%变为70.8±20.3%，p<0.001）。QRS波时限平均缩短31.3毫秒（从165.1±16.3降至133.8±12.7，p<0.001），B型利钠肽（以皮克/毫升为单位）从834±350降至621±283（p<0.001）。射血分数（以百分比为单位）从27.5±4.增加到33.3±4.4（p<0.001），二尖瓣反流严重程度降低一级（从2.7±0.9降至1.8±0.7，p<0.05）。
右心室双焦点起搏似乎能为有传统CRT适应症的心力衰竭患者带来显著临床益处，当左心室入路不成功时可能是一种替代选择。
