Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey;
J Thorac Dis. 2013 Oct;5(5):650-7. doi: 10.3978/j.issn.2072-1439.2013.10.15.
This study compared patients who underwent cardiac resynchronization therapy (CRT) by high-amplitude left ventricular (LV) pacing with those who underwent CRT by standard LV pacing.
We included 32 CRT patients with ejection fraction (EF) ≤35%, QRS time ≥120 ms, and New York Heart Association (NYHA) class III/IV symptoms of heart failure despite optimal medical treatment. These patients were evaluated clinically and echocardiographically before, three and six months after CRT. At the 3(rd) month, the LV pulse amplitude value was set high at 5 volt for 16 patients [high-amplitude Group (HAG)], while for the other 16 patients, it was reduced to at least twice the threshold value at ≤2.5 volt [low-amplitude group (LAG)].
Clinical and echocardiographic response rates of HAG and LAG after CRT were similar in the 3(rd) and 6(th) month. In both groups, increase in LVEF and decrease in LV ESV in the 3(rd) and 6(th) month were statistically significant compared to those before CRT, and NYHA class and end-diastolic volume (EDV) was significantly reduced in the 6(th) month compared to those before CRT. However, NHYA class and EDV continued to reduce significantly in HAG from the 3(rd) to the 6(th) month (P<0.05), while the decrease in LAG was not significant (P>0.05). The rate of mitral regurgitation (MR) was reduced significantly in HAG in the 6(th) month compared to that before CRT, while the decrease in LAG was not significant (P<0.05; P>0.05 respectively).
CRT by high-amplitude LV pacing was more effective according to clinical and echocardiographic evaluations. It should be considered as an alternative in non-responsive patients.
本研究比较了高振幅左心室（LV）起搏和标准 LV 起搏行心脏再同步治疗（CRT）的患者。
我们纳入了 32 名射血分数（EF）≤35%、QRS 时间≥120ms、且尽管接受了最佳药物治疗但仍有纽约心脏协会（NYHA）III/IV 级心力衰竭症状的 CRT 患者。这些患者在 CRT 前、后 3 个月和 6 个月进行临床和超声心动图评估。在第 3 个月，将 16 名患者的 LV 脉冲幅度值设置为 5 伏（高振幅组，HAG），而将另外 16 名患者的 LV 脉冲幅度值降低至≤2.5 伏（低振幅组，LAG），至少为阈值的两倍。
HAG 和 LAG 患者 CRT 后 3 个月和 6 个月的临床和超声心动图反应率相似。在两组中，与 CRT 前相比，第 3 个月和第 6 个月 LVEF 增加，LVESV 减少，且在第 6 个月与 CRT 前相比，NYHA 分级和舒张末期容积（EDV）显著降低。然而，与第 3 个月相比，HAG 组的 NYHA 分级和 EDV 在第 6 个月持续显著降低（P<0.05），而 LAG 组的降低不显著（P>0.05）。与 CRT 前相比，HAG 组在第 6 个月时 MR 发生率显著降低，而 LAG 组的降低不显著（P<0.05；P>0.05）。
根据临床和超声心动图评估，高振幅 LV 起搏的 CRT 更有效。对于无反应的患者，应考虑作为替代方案。
