Miyazaki Aya, Sakaguchi Heima, Kagisaki Koji, Tsujii Nobuyuki, Matsuoka Michio, Yamamoto Tetsuya, Hoashi Takaya, Noda Takashi, Ohuchi Hideo
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Europace. 2016 Jan;18(1):100-12. doi: 10.1093/europace/euu401. Epub 2015 Mar 4.
This study aims to assess the impact of pacing sites on the effectiveness of cardiac resynchronization therapy (CRT) in systemic right ventricle (sRV) patients with/without a rudimentary left ventricle (rLV).
We evaluated 13 procedures in 11 sRV patients with a wide QRS (>150 ms). Based on the digitalization results of ventriculography, long-axis dyssynchrony (LD) was defined as extremely delayed right ventricular (RV) outflow tract movement: ≥100 ms delay from the RV apical contraction, and short-axis dyssynchrony (SD) was defined as a paradoxical contraction between the rLV and sRV caused by a conduction delay between the two ventricles. During the follow-up period (2.1 ± 1.9 years), the response rates were 71% (5/7) and 33% (2/6) in the sRV patients with and without an rLV, respectively (P = ns). Following the CRT, the QRS duration remained similar between the responders and nonresponders. Among five responders with an rLV, the leads were placed in the longitudinal RV direction in two with LD, longitudinal RV direction with fusion of the intrinsic QRS in two with LD + SD, and laterally on opposite sides of both ventricles in one with SD. Among two responders without an rLV, the leads were placed in the longitudinal RV direction in those two with LD.
In sRV patients with LD with/without an rLV, the leads should be placed at furthest sites in the longitudinal RV direction. In patients with an rLV and SD, the leads should be placed laterally on opposite sides of both ventricles.
本研究旨在评估起搏部位对合并或不合并残余左心室（rLV）的系统性右心室（sRV）患者心脏再同步治疗（CRT）有效性的影响。
我们评估了11例宽QRS（>150 ms）的sRV患者的13次手术。根据心室造影的数字化结果，长轴不同步（LD）定义为右心室（RV）流出道运动极度延迟：较RV心尖收缩延迟≥100 ms，短轴不同步（SD）定义为两个心室之间的传导延迟导致rLV和sRV之间的矛盾收缩。在随访期（2.1±1.9年），合并rLV的sRV患者和不合并rLV的sRV患者的反应率分别为71%（5/7）和33%（2/6）（P=无显著差异）。CRT后，反应者和无反应者的QRS时限保持相似。在5例合并rLV的反应者中，2例LD患者的电极置于RV纵向，2例LD+SD患者的电极置于RV纵向并融合固有QRS，1例SD患者的电极置于两个心室相对侧的外侧。在2例不合并rLV的反应者中，2例LD患者的电极置于RV纵向。
在合并或不合并rLV的LD的sRV患者中，电极应置于RV纵向最远的部位。在合并rLV和SD的患者中，电极应置于两个心室相对侧的外侧。
