Punn Rajesh, Hanisch Debra, Motonaga Kara S, Rosenthal David N, Ceresnak Scott R, Dubin Anne M
Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA.
J Cardiovasc Electrophysiol. 2016 Feb;27(2):210-6. doi: 10.1111/jce.12863. Epub 2015 Nov 23.
Cardiac resynchronization therapy indications and management are well described in adults. Echocardiography (ECHO) has been used to optimize mechanical synchrony in these patients; however, there are issues with reproducibility and time intensity. Pediatric patients add challenges, with diverse substrates and limited capacity for cooperation. Electrocardiographic (ECG) methods to assess electrical synchrony are expeditious but have not been extensively studied in children. We sought to compare ECHO and ECG CRT optimization in children.
Prospective, pediatric, single-center cross-over trial comparing ECHO and ECG optimization with CRT. Patients were assigned to undergo either ECHO or ECG optimization, followed for 6 months, and crossed-over to the other assignment for another 6 months. ECHO pulsed-wave tissue Doppler and 12-lead ECG were obtained for 5 VV delays. ECG optimization was defined as the shortest QRSD and ECHO optimization as the lowest dyssynchrony index. ECHOs/ECGs were interpreted by readers blinded to optimization technique. After each 6 month period, these data were collected: ejection fraction, velocimetry-derived cardiac index, quality of life, ECHO-derived stroke distance, M-mode dyssynchrony, study cost, and time. Outcomes for each optimization method were compared.
From June 2012 to December 2013, 19 patients enrolled. Mean age was 9.1 ± 4.3 years; 14 (74%) had structural heart disease. The mean time for optimization was shorter using ECG than ECHO (9 ± 1 min vs. 68 ± 13 min, P < 0.01). Mean cost for charges was $4,400 ± 700 less for ECG. No other outcome differed between groups.
ECHO optimization of synchrony was not superior to ECG optimization in this pilot study. ECG optimization required less time and cost than ECHO optimization.
心脏再同步治疗的适应症和管理在成人中已有详尽描述。超声心动图（ECHO）已被用于优化这些患者的机械同步性；然而，存在可重复性和时间强度方面的问题。儿科患者面临更多挑战，其心脏病变情况多样且合作能力有限。评估电同步性的心电图（ECG）方法虽快捷，但在儿童中尚未得到广泛研究。我们旨在比较儿童中ECHO和ECG用于心脏再同步治疗（CRT）优化的情况。
一项前瞻性、儿科单中心交叉试验，比较ECHO和ECG用于CRT优化的情况。患者被分配接受ECHO或ECG优化，随访6个月，然后交叉接受另一项优化再随访6个月。获取ECHO脉冲波组织多普勒和12导联ECG以测量5个室间延迟。ECG优化定义为最短的QRSD（QRS波群时限），ECHO优化定义为最低的不同步指数。ECHOs/ECGs由对优化技术不知情的读者解读。在每个6个月周期后，收集以下数据：射血分数、速度测量得出的心脏指数、生活质量、ECHO得出的每搏输出距离、M型不同步性、研究成本和时间。比较每种优化方法的结果。
2012年6月至2013年12月，19名患者入组。平均年龄为9.1±4.3岁；14名（74%）患有结构性心脏病。使用ECG进行优化的平均时间比ECHO短（9±1分钟对68±13分钟，P<0.01）。ECG的平均收费成本比ECHO少4400±700美元。两组间其他结果无差异。
在这项初步研究中，ECHO同步性优化并不优于ECG优化。与ECHO优化相比，ECG优化所需时间和成本更少。
