右束支传导阻滞患者的右心室间隔起搏
Right ventricular septal pacing in patients with right bundle branch block.
作者信息
Giudici Michael C, Abu-El-Haija Basil, Schrumpf Phillip E, Bhave Prashant D, Al Khiami Belal, Barold Serge S
机构信息
Division of Cardiology, University of Iowa Hospitals, Iowa City, Iowa.
Division of Cardiology, University of Iowa Hospitals, Iowa City, Iowa.
出版信息
J Electrocardiol. 2015 Jul-Aug;48(4):626-9. doi: 10.1016/j.jelectrocard.2015.04.018. Epub 2015 May 1.
BACKGROUND
Cardiac resynchronization therapy (CRT) has been shown to improve left ventricular (LV) function and exercise performance in patients with left bundle branch block. Patients with right bundle branch block (RBBB) do not have a similar positive response to standard CRT. We hypothesized that single site pacing of the right ventricular septum (RVS) near the proximal right bundle could restore more normal activation of the LV in RBBB patients.
METHODS
78 consecutive patients (56 M, 22 F) with baseline RBBB underwent pacemaker or ICD implantation. Leads were placed in the right atrium and RVS.
RESULTS
Baseline QRS duration was 120-220 ms (mean QRSd = 147 ms). At the optimal AV delay, the fused QRSd was 56-160 ms (mean QRSd = 112 ms). The mean decrease in QRSd was 34 ± 20.4 ms (p<0.001).
CONCLUSION
RVS pacing in patients with RBBB resulted in a marked decrease in QRS duration and often normalized the ECG.
背景
心脏再同步治疗（CRT）已被证明可改善左束支传导阻滞患者的左心室（LV）功能和运动表现。右束支传导阻滞（RBBB）患者对标准CRT没有类似的积极反应。我们假设在右束支近端附近的右心室间隔（RVS）进行单部位起搏可以恢复RBBB患者左心室更正常的激活。
方法
78例基线为RBBB的连续患者（56例男性，22例女性）接受了起搏器或植入式心脏复律除颤器（ICD）植入。电极导线放置在右心房和RVS。
结果
基线QRS时限为120 - 220毫秒（平均QRSd = 147毫秒）。在最佳房室延迟时，融合后的QRSd为56 - 160毫秒（平均QRSd = 112毫秒）。QRSd的平均减少量为34±20.4毫秒（p<0.001）。
结论
RBBB患者的RVS起搏导致QRS时限显著缩短，且常使心电图恢复正常。
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