Rossillo Antonio, Ramondo Angelo B
Cardiology Department, San Bortolo Hospital. Vicenza, Italy.
J Atr Fibrillation. 2016 Feb 29;8(5):1365. doi: 10.4022/jafib.1365. eCollection 2016 Feb-Mar.
Cardiac resynchronization therapy (CRT) is an accepted treatment for patients with heart failure (HF), impaired left ventricular (LV) function, and a wide QRS complex. However, more than 30% of eligible patients fail to benefit from CRT. It is clearly necessary to define the characteristics of the best candidates for this therapy. To this end, surface ECG and echocardiography have been tested. Unfortunately, however, neither of these examinations has proved sufficiently able to identify the best patients. A tailored approach based on the evaluation of both electrical and mechanical delay to guide LV lead placement seems to be the most reasonable strategy in order to increase the efficacy of CRT therapy. The good preliminary data that have been published suggest that using intracardiac echocardiography to define the mechanical delay could be an interesting option. Moreover, at present it is the only option available that can enable intraprocedural evaluation of the mechanical activation sequence. Naturally, further randomized studies with larger populations should be performed in order to ascertain the real benefit of this approach and to evaluate whether it will outweigh the additional cost of this technology.
心脏再同步治疗（CRT）是治疗心力衰竭（HF）、左心室（LV）功能受损且QRS波群增宽患者的一种公认疗法。然而，超过30%的符合条件的患者未能从CRT中获益。明确界定该疗法最佳候选者的特征显然很有必要。为此，已对体表心电图和超声心动图进行了测试。然而，遗憾的是，这两种检查都未充分证明能够识别出最佳患者。为提高CRT治疗的疗效，基于评估电延迟和机械延迟以指导左心室导线置入的个体化方法似乎是最合理的策略。已发表的良好初步数据表明，使用心腔内超声心动图来界定机械延迟可能是一个有意思的选择。此外，目前它是唯一能够在手术过程中评估机械激活顺序的可用选项。当然，应该开展更多纳入更大样本量人群的随机研究，以确定这种方法的实际益处，并评估其是否会超过该技术的额外成本。
