From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
Circ Arrhythm Electrophysiol. 2014 Oct;7(5):968-77. doi: 10.1161/CIRCEP.114.001360.
The results from numerous clinical studies provide guidance for optimizing outcomes related to RV or biventricular pacing in the pacemaker and ICD populations. (1) Programming algorithms to minimize RV pacing is imperative in patients with dual-chamber pacemakers who have intrinsic AV conduction or intermittent AV conduction block. (2) Dual-chamber ICDs should be avoided in candidates without an indication for bradycardia pacing. (3) Alternate RV septal pacing sites may be considered at the time of pacemaker implantation. (4) Biventricular pacing may be beneficial in some patients with mild LV dysfunction. (5) LV lead placement at the site of latest LV activation is desirable. (6) Programming CRT systems to achieve biventricular/LV pacing >98.5% is important. (7) Protocols for AV and VV optimization in patients with CRT are not recommended after device implantation but may be considered for CRT nonresponders. (8) Novel algorithms to maximize the benefit of CRT are in evolution further.
大量临床研究的结果为优化与 RV 或双心室起搏相关的起搏器和 ICD 人群的结局提供了指导。(1) 对于具有固有 AV 传导或间歇性 AV 传导阻滞的双腔起搏器患者，必须制定最小化 RV 起搏的程控算法。(2) 对于没有心动过缓起搏指征的患者，应避免使用双腔 ICD。(3) 在起搏器植入时可以考虑替代 RV 间隔起搏部位。(4) 在某些轻度 LV 功能障碍的患者中，双心室起搏可能有益。(5) 在 LV 最后激活部位放置 LV 导联是理想的。(6) 为实现 biventricular/LV 起搏>98.5%，重要的是对 CRT 系统进行编程。(7) 在装置植入后不推荐对 CRT 患者进行 AV 和 VV 优化的方案，但可能会考虑对 CRT 无反应者进行优化。(8) 进一步开发了最大限度提高 CRT 效益的新型算法。
