Janouek J, Kovalev I A, Kubu P, Chernyshev A A, Krivoshchekov E V, Krivolapov S N, Sokolov A A
Research Institute for Cardiology of the Research Centre of RAMS Siberian Branch, ul. Kievskaya 111a, 634012 Tomsk, Russia Childrens Heart Centre, University Hospital Motol, Prague, Czech Republic.
Kardiologiia. 2015 Feb;55(2):87-95.
Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.
心脏再同步治疗（CRT）目前是治疗成人心力衰竭的主要方法。然而，关于CRT在儿童中的应用数据仍然有限，且CRT的适应症尚不清楚。有证据表明，对于因完全房室传导阻滞患者右心室传统刺激介导的不同步导致心力衰竭的儿童群体，给予CRT可获得最佳治疗效果。相反，扩张型心肌病的存在和心功能Ⅲ-Ⅳ级心力衰竭是CRT无效的预测因素。儿童CRT设备的植入有许多与儿童年龄的解剖和生理特征相关的特殊性和挑战。考虑到预期的治疗时长，应承认心外膜双心室刺激更为可取。在本文中，作者讨论了电机械不同步的病理生理学，分析了他们自己的CRT经验，并提出了这种治疗的适应症。
