超声心动图组织同步成像在心脏再同步治疗中重新定位左心室心外膜导联的作用。

Utility of echocardiographic tissue synchronization imaging to redirect left ventricular epicardial lead placement for cardiac resynchronization therapy.

机构信息

Department of Echo, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.

出版信息

Chin Med J (Engl). 2013 Nov;126(22):4222-6.

PMID:24238501

Abstract

BACKGROUND

Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure (HF). It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit. This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure.

METHODS

Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association (NYHA) Class III-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years ((59.6 ± 9.2) years). The mean left ventricular ejection fraction (LVEF) was (33.6 ± 7.4)%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement.

RESULTS

Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from III-IV preoperatively to II-III postoperatively. The left ventricular end-diastolic diameter (LVEDD) decreased from (67.9 ± 12.7) mm to (61.2 ± 7.1) mm (P < 0.05), and LVEF increased from (33.6 ± 7.4)% to (42.2 ± 8.8)% (P < 0.05). Left ventricular intraventricular dyssynchrony index decreased from (148.4 ± 31.6) ms to (57.3 ± 23.8) ms (P < 0.05).

CONCLUSIONS

Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal target location.

摘要

背景

心脏再同步治疗（CRT）结合双心室起搏已被证明可改善充血性心力衰竭（HF）患者的心脏功能。已经证明，将左心室导联放置在收缩延迟时间最长的节段可获得最佳的 CRT 获益。本研究描述了一种用于 CRT 的手术技术，为心力衰竭患者提供了一种可行的替代方案。

方法

2007 年 4 月至 2012 年 6 月，共有 14 例连续的纽约心脏协会（NYHA）III-IV 级心力衰竭患者通过手术方法接受左心室心外膜导联植入。其中男性 8 例，女性 6 例，年龄 36-79 岁（59.6±9.2 岁）。左心室射血分数（LVEF）平均值为（33.6±7.4）%。所有患者均有左心室收缩不同步，并通过手术方法进行左心室心外膜导联植入。组织多普勒成像（TDI）和术中经食管超声心动图用于评估左心功能和不同步参数的变化。此外，超声心动图用于选择左心室心外膜导联植入的最佳部位。

结果

所有患者均成功地将左心室心外膜导联植入后外侧心外膜壁，无严重并发症。所有患者的 NYHA 评分均从术前 III-IV 级降至术后 II-III 级。左心室舒张末期直径（LVEDD）从（67.9±12.7）mm 降至（61.2±7.1）mm（P<0.05），左心室射血分数（LVEF）从（33.6±7.4）%升至（42.2±8.8）%（P<0.05）。左心室室内不同步指数从（148.4±31.6）ms 降至（57.3±23.8）ms（P<0.05）。