Marques Pedro, Nobre Menezes Miguel, Lima da Silva Gustavo, Bernardes Ana, Magalhães Andreia, Cortez-Dias Nuno, Carpinteiro Luís, de Sousa João, Pinto Fausto J
Cardiology Department, University Hospital Santa Maria, Centro Hospitalar de Lisboa Norte, CCUL, University of Lisbon, Portugal.
Cardiology Department, University Hospital Santa Maria, Centro Hospitalar de Lisboa Norte, CCUL, University of Lisbon, Portugal.
Rev Port Cardiol. 2016 Jun;35(6):331-8. doi: 10.1016/j.repc.2015.12.006. Epub 2016 May 30.
Multi-site pacing is emerging as a new method for improving response to cardiac resynchronization therapy (CRT), but has been little studied, especially in patients with atrial fibrillation. We aimed to assess the effects of triple-site (Tri-V) vs. biventricular (Bi-V) pacing on hemodynamics and QRS duration.
This was a prospective observational study of patients with permanent atrial fibrillation and ejection fraction <40% undergoing CRT implantation (n=40). One right ventricular (RV) lead was implanted in the apex and another in the right ventricular outflow tract (RVOT) septal wall. A left ventricular (LV) lead was implanted in a conventional venous epicardial position. Cardiac output (using the FloTrac™ Vigileo™ system), mean QRS and ejection fraction were calculated.
Mean cardiac output was 4.81±0.97 l/min with Tri-V, 4.68±0.94 l/min with RVOT septal and LV pacing, and 4.68±0.94 l/min with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV). Mean pre-implantation QRS was 170±25 ms, 123±18 ms with Tri-V, 141±25 ms with RVOT septal pacing and LV pacing and 145±19 with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV and pre-implantation). Mean ejection fraction was significantly higher with Tri-V (30±11%) vs. Bi-V pacing (28±12% with RVOT septal and LV pacing and 28±11 with RV apical and LV pacing) and pre-implantation (25±8%).
Tri-V pacing produced higher cardiac output and shorter QRS duration than Bi-V pacing. This may have a significant impact on the future of CRT.
多部位起搏作为一种改善心脏再同步治疗（CRT）反应的新方法正在兴起，但相关研究较少，尤其是在心房颤动患者中。我们旨在评估三部位（Tri-V）起搏与双心室（Bi-V）起搏对血流动力学和QRS时限的影响。
这是一项对40例植入CRT的永久性心房颤动且射血分数<40%患者的前瞻性观察研究。一根右心室（RV）导线植入心尖，另一根植入右心室流出道（RVOT）间隔壁。一根左心室（LV）导线植入传统的静脉心外膜位置。计算心输出量（使用FloTrac™ Vigileo™系统）、平均QRS和射血分数。
Tri-V起搏时平均心输出量为4.81±0.97升/分钟，RVOT间隔和LV起搏时为4.68±0.94升/分钟，RV心尖和LV起搏时为4.68±0.94升/分钟（Tri-V与两种BiV起搏相比，p<0.001）。植入前平均QRS为170±25毫秒，Tri-V起搏时为123±18毫秒，RVOT间隔起搏和LV起搏时为141±25毫秒，RV心尖和LV起搏时为145±19毫秒（Tri-V与BiV起搏及植入前相比，p<0.001）。Tri-V起搏时平均射血分数（30±11%）显著高于Bi-V起搏（RVOT间隔和LV起搏时为28±12%，RV心尖和LV起搏时为28±11%）及植入前（25±8%）。
与Bi-V起搏相比，Tri-V起搏产生更高的心输出量和更短的QRS时限。这可能对CRT的未来产生重大影响。
