Lucas C M H B, Cleuren G V J, Kirchhof C J H J
Neth Heart J. 2006 Jan;14(1):14-18.
In patients with chronic heart failure (CHF), the presence of conduction delay across the myocardium is a well-known feature. During recent years an increasing number of CHF patients have been treated with cardiac resynchronisation therapy (CRT). So far in many protocols patients have been selected using the criteria of left ventricular ejection fraction (LVEF) ≤35% concomitant with signs of widening of the QRS on the surface electrocardiogram, either with or without left bundle branch block (LBBB) morphology.
In this article we discuss which of the patients admitted with CHF to a regular cardiology practice could be candidates for this therapy. Data were obtained from January 2000 to December 2004 on a total of 861 CHF patients, of whom 309 had an LVEF ≤35%. Of these patients, 123 patients showed a QRS width >120 msec, while 81 patient had a QRS width >140 msec. In total, 89 patients had an LBBB morphology on the electrocardiogram, while 21 patients had univentricular pacing devices in situ. In those patients with an LVEF >35%, QRS width was 108±27msec.
A substantial number of patients presenting with CHF in a regular cardiology practice are suitable candidates for CRT therapy according to currently used criteria of QRS width and LVEF. This number could be increased even more if recent information concerning intraventricular conduction delay in CHF patients with less widening of the QRS complex were to be applied, as judged by echocardiographic techniques.
在慢性心力衰竭（CHF）患者中，心肌传导延迟的存在是一个众所周知的特征。近年来，越来越多的CHF患者接受了心脏再同步治疗（CRT）。到目前为止，在许多方案中，患者是根据左心室射血分数（LVEF）≤35%以及体表心电图上QRS波增宽的体征来选择的，无论有无左束支传导阻滞（LBBB）形态。
在本文中，我们讨论了在普通心脏病科就诊的CHF患者中哪些可能是这种治疗的候选者。数据收集于2000年1月至2004年12月，共861例CHF患者，其中309例LVEF≤35%。在这些患者中，123例QRS波宽度>120毫秒，81例QRS波宽度>140毫秒。总共有89例患者心电图呈LBBB形态，21例患者已植入单心室起搏装置。在LVEF>35%的患者中，QRS波宽度为108±27毫秒。
根据目前使用的QRS波宽度和LVEF标准，在普通心脏病科就诊的大量CHF患者是CRT治疗的合适候选者。如果应用有关QRS波群增宽较小的CHF患者室内传导延迟的最新信息（通过超声心动图技术判断），这个数字可能会进一步增加。
