Stabile Giuseppe, Bianchi Valter, Solimene Francesco, Iuliano Assunta, Parisi Quintino, Pepi Patrizia, Bocchiardo Mario, Urraro Francesco, De Simone Antonio, Ospizio Roberto, D'Onofrio Antonio
Clinica Mediterranea, Via Orazio 2, 80122, Naples, Italy.
Ospedale dei Colli-Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
J Interv Card Electrophysiol. 2017 Oct;50(1):111-115. doi: 10.1007/s10840-017-0279-x. Epub 2017 Aug 10.
Identifying the left ventricular (LV) site associated with the maximum spontaneous interventricular conduction time (right ventricle (RV)-to-LV interval) has proved to be an effective strategy for optimal LV pacing site selection in cardiac resynchronization therapy (CRT). The aim of our study was to determine whether quadripolar LV lead technology allows RV-to-LV interval maximization.
We enrolled 108 patients undergoing implantation of a CRT system using an LV quadripolar lead and 114 patients who received a bipolar lead. On implantation, the RV-to-LV interval was measured for the dipole of the bipolar leads and for each electrode of the LV lead (tip, ring 2, ring 3, ring 4).
In the quadripolar group, the mean RV-to-LV interval ranged from 90 ± 33 ms (tip) to 94 ± 32 ms (R4) (p > 0.05 for all comparisons). In 55 (51%) patients, the RV-to-LV interval was > 80 ms at all electrodes, while in 27 (25%) patients, no electrodes were associated with an RV-to-LV interval > 80 ms. At least one LV pacing electrode was associated with an RV-to-LV interval > 80 ms in 62 (70%) patients with a short (36 mm) inter-electrode distance, and in 19 (95%, p = 0.022) of those with a long distance (50.5 mm). In the bipolar group, the mean RV-to-LV interval was 72 ± 37 ms (p < 0.001 versus quadripolar). The RV-to-LV interval was > 80 ms in 44 (39%) patients (p < 0.001 versus quadripolar leads with both short and long inter-electrode distance).
Quadripolar leads allow RV-to-LV interval maximization. An optimal RV-to-LV interval seems achievable in the majority of patients, especially if the leads present a long inter-electrode distance.
确定与最大自发心室间传导时间（右心室至左心室间期）相关的左心室（LV）部位已被证明是心脏再同步治疗（CRT）中选择最佳左心室起搏部位的有效策略。我们研究的目的是确定四极左心室导线技术是否能使右心室至左心室间期最大化。
我们纳入了108例使用左心室四极导线植入CRT系统的患者和114例接受双极导线的患者。在植入时，测量双极导线偶极以及左心室导线每个电极（尖端、环2、环3、环4）的右心室至左心室间期。
在四极导线组中，平均右心室至左心室间期范围为90±33毫秒（尖端）至94±32毫秒（R4）（所有比较的p>0.05）。在55例（51%）患者中，所有电极的右心室至左心室间期均>80毫秒，而在27例（25%）患者中，没有电极的右心室至左心室间期>80毫秒。在电极间距短（36毫米）的62例（70%）患者中，至少有一个左心室起搏电极的右心室至左心室间期>80毫秒，在电极间距长（50.5毫米）的患者中有19例（95%，p=0.022）。在双极导线组中，平均右心室至左心室间期为72±37毫秒（与四极导线组相比，p<0.001）。44例（39%）患者的右心室至左心室间期>80毫秒（与电极间距短和长的四极导线相比，p<0.001）。
四极导线可使右心室至左心室间期最大化。在大多数患者中似乎可以实现最佳的右心室至左心室间期，特别是如果导线的电极间距长。
