Department of Medicine, University of Washington, Seattle, Washington.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 2016 Mar 8;67(9):1104-1117. doi: 10.1016/j.jacc.2015.12.039.
The beneficial effects of cardiac resynchronization therapy (CRT) have been well established in large, randomized trials. Despite the documented success of this treatment strategy, a significant proportion of patients with heart failure do not achieve the desired response. The aim of this review was to delineate factors contributing to a successful CRT response, emphasizing the interrelated roles of QRS morphology and QRS interval duration. More data are available on QRS duration, as this factor has been used as an enrollment criterion in clinical trials. Response to CRT seems to increase as the QRS duration becomes longer, with greatest benefit in QRS duration ≥150 ms. Recent data have placed more emphasis on QRS morphology, demonstrating variability in clinical response between patients with left bundle branch block, non-left bundle branch block, and right bundle branch block morphology. Notably, myocardial scarring and cardiac dimensions, among other variables, may alter heterogeneity in ventricular activation. Understanding the electrophysiological underpinnings of the QRS complex has become important not only to predict response but also to facilitate the patient-specific delivery of resynchronization therapy.
心脏再同步治疗（CRT）的有益效果已在大型随机试验中得到充分证实。尽管这种治疗策略取得了有案可稽的成功，但仍有相当一部分心力衰竭患者未能达到预期的反应。本综述的目的是阐明导致 CRT 反应成功的因素，强调 QRS 形态和 QRS 间隔持续时间的相互关联作用。更多的数据可用于 QRS 持续时间，因为该因素已被用作临床试验中的入组标准。随着 QRS 持续时间的延长，对 CRT 的反应似乎会增加，而 QRS 持续时间≥150ms 的获益最大。最近的数据更加重视 QRS 形态，表明左束支传导阻滞、非左束支传导阻滞和右束支传导阻滞形态的患者之间的临床反应存在差异。值得注意的是，心肌瘢痕和心脏尺寸等其他变量可能改变心室激动的异质性。了解 QRS 复合体的电生理基础不仅对预测反应很重要，而且对促进针对患者的心脏再同步治疗也很重要。
