Eschalier Romain, Ploux Sylvain, Ritter Philippe, Haïssaguerre Michel, Ellenbogen Kenneth A, Bordachar Pierre
Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France; Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR6284, and CHU Clermont-Ferrand, Cardiology Department, F-63003 Clermont-Ferrand, France.
Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France.
Heart Rhythm. 2015 May;12(5):1071-9. doi: 10.1016/j.hrthm.2015.01.023. Epub 2015 Jan 19.
Cardiac resynchronization therapy (CRT) is an electrical treatment of heart failure with reduced ejection fraction and wide QRS. It aims to correct the electrical dyssynchrony present in 30% to 50% of patients in this population. Dyssynchrony results in widening of the QRS complex on the electrocardiogram (ECG). CRT was initially developed to treat patients who had left bundle branch block (LBBB) and delayed activation of the lateral left ventricular wall. However, a large proportion of heart failure patients present with a widened QRS that is neither an LBBB nor a right bundle branch block (RBBB): nonspecific intraventricular conduction delay (NICD). Less studied than RBBB or LBBB, its pathophysiology is both complex and varied yet still reflects intramyocardial conduction delay. NICD is most often associated with cardiomyopathy (eg, ischemic or hypertensive). Conduction pathways can be either healthy or affected. Results from CRT are contradictory in this patient group, despite a seemingly neutral trend. Unfortunately, prospective studies are lacking. Guidelines recommending implantation of CRT devices in this group are based solely on analyses of subgroups with small sample sizes. A dedicated prospective study is therefore warranted for this question to be answered properly. A detailed study of the ECG and noninvasive study of ventricular electrical activation may enable clinicians to better identify patients with NICD who will respond to CRT.
心脏再同步治疗（CRT）是一种针对射血分数降低且QRS波增宽的心力衰竭的电治疗方法。其目的是纠正该人群中30%至50%患者存在的电不同步。不同步会导致心电图（ECG）上QRS波群增宽。CRT最初是为治疗患有左束支传导阻滞（LBBB）且左心室侧壁激活延迟的患者而开发的。然而，很大一部分心力衰竭患者的QRS波增宽既不是LBBB也不是右束支传导阻滞（RBBB）：非特异性室内传导延迟（NICD）。与RBBB或LBBB相比，对其研究较少，其病理生理学既复杂又多样，但仍反映心肌内传导延迟。NICD最常与心肌病（如缺血性或高血压性）相关。传导通路可能正常也可能受影响。尽管有看似中性的趋势，但CRT在该患者组中的结果相互矛盾。不幸的是，缺乏前瞻性研究。推荐在该组中植入CRT设备的指南仅基于对小样本量亚组的分析。因此，有必要进行一项专门的前瞻性研究来正确回答这个问题。对心电图的详细研究和对心室电激活的无创研究可能使临床医生能够更好地识别对CRT有反应的NICD患者。
