Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
Europace. 2014 Oct;16(10):1476-81. doi: 10.1093/europace/euu136. Epub 2014 Jun 3.
The choice of left ventricular pacing configurations (LVPCs) of quadripolar leads used for cardiac resynchronization therapy (CRT) affects haemodynamic response and thus may be a tool for device optimization. The value of surface electrocardiograms and interventricular time delays (IVDs) for optimization is unknown.
Sixteen patients implanted with a CRT device with a quadripolar LV lead underwent invasive testing of LV dP/dt. QRS durations at baseline (bl) and during biventricular pacing (biv) were measured using different LVPCs (total of 141 LVPCs; 8.8 per patient). Variations in QRS duration during biv were calculated for each patient (ΔQRS) and, when compared with intrinsic QRS duration, for all LVPCs (ΔQRSLVPC). Interventricular time delays between the poles of the LV lead were obtained from intracardiac electrograms. ΔIVD was calculated as IVDmax - IVDmin. Parameters were correlated with LV dP/dt. ΔQRS and ΔQRSLVPC both significantly correlated with LV dP/dt (P < 0.01). Correlation was found for patients with ischaemic (P < 0.001) and non-ischaemic cardiomyopathy (P < 0.05), and for patients with bl QRS duration >168 ms (P < 0.001), but not <168 ms (P = ns). The LVPC with shortest QRS duration also yielded maximal LV dP/dt in 6 of 16 patients (37.5%), and was equal or better in LV dP/dt in 12 of 16 patients (75%). ΔIVD neither correlated with ΔQRS nor ΔLV dP/dt.
ΔQRS predicts the maximal value of vector personalization in the individual. Reductions in QRS width, but not IVDs, correlate with acute haemodynamic response. Intraindividually, in 75% of patients, the LVPC with the shortest QRS duration gives equal or superior haemodynamic results when compared with the LVPC with longest QRS duration.
用于心脏再同步治疗（CRT）的四极导线的左心室起搏配置（LVPC）的选择会影响血液动力学反应，因此可能成为设备优化的工具。表面心电图和室间时间延迟（IVD）的优化价值尚不清楚。
16 名植入具有四极 LV 导线的 CRT 设备的患者接受了 LV dP/dt 的侵入性测试。使用不同的 LVPC 测量了基线（BL）和双心室起搏（BIV）期间的 QRS 持续时间（总共 141 个 LVPC；每个患者 8.8 个）。为每个患者计算了 BIV 期间 QRS 持续时间的变化（ΔQRS），并将所有 LVPC 的 QRS 持续时间（ΔQRSLVPC）与固有 QRS 持续时间进行比较。从心内电图获得 LV 导线上两极之间的 IVD。计算 IVDmax- IVDmin 作为 ΔIVD。参数与 LV dP/dt 相关。ΔQRS 和 ΔQRSLVPC 均与 LV dP/dt 显著相关（P < 0.01）。在缺血性（P < 0.001）和非缺血性心肌病（P < 0.05）患者中发现了相关性，并且在 BL QRS 持续时间>168 ms（P < 0.001）的患者中，但 BL QRS 持续时间<168 ms 的患者中没有相关性（P = ns）。在 16 名患者中的 6 名（37.5%）中，具有最短 QRS 持续时间的 LVPC 也产生了最大的 LV dP/dt，并且在 16 名患者中的 12 名（75%）中等于或优于 LV dP/dt。ΔIVD 与 ΔQRS 或 ΔLV dP/dt 均不相关。
ΔQRS 预测了个体中向量个性化的最大值。QRS 宽度的减小，但不是 IVD，与急性血液动力学反应相关。在个体中，在 75%的患者中，与具有最长 QRS 持续时间的 LVPC 相比，具有最短 QRS 持续时间的 LVPC 产生了相等或更好的血液动力学结果。
