Gu Min, Jin Han, Hua Wei, Fan Xiao-Han, Ding Li-Gang, Wang Jing, Niu Hong-Xia, Cai Chi, Zhang Shu
The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2017 Sep;96(37):e8066. doi: 10.1097/MD.0000000000008066.
This study aimed to investigate whether repetitive optimizing left ventricular pacing configurations (LVPCs) with quadripolar leads (QUAD) can improve response to cardiac resynchronization therapy (CRT).
Fifty-two eligible patients were enrolled and 1:1 randomized to either the quadripolar LV leads (QUAD) group or the conventional bipolar leads (CONV) group. In the QUAD group, optimization of LVPC was performed for all patients before discharge and for nonresponders at 3 months follow-up. Clinical evaluations and transthoracic echocardiograms were performed before, 3, and 6 months after CRT implantation.
At 3 months follow-up, 16 of 25 (64%) patients in the CONV group (1 patient was lost to follow-up) and 18 of 26 (69%) patients in the QUAD group were classified as responders. After optimizing the LVPCs in 3-month nonresponders in the QUAD group, 21 of 26 (80.8%) patients in the QUAD group were classified as responders at 6 months as compared with 17 of 25 (68%) patients in the CONV group. Left ventricular end-systolic volume (LVESV) reduction, left ventricular ejection fraction (LVEF) increase, and New York Heart Association (NYHA) functional class reduction at 6 months were significantly greater in the QUAD group than in the CONV group (LVESV: -26.9 ± 13.8 vs -17.2 ± 13.3%; P = .013; LVEF: +12.7 ± 8.0 vs +7.8 ± 6.3 percentage points; P = .017; NYHA: -1.27 ± 0.67 vs -0.72 ± 0.54 functional classes; P = .002).
Compared with conventional bipolar leads, CRT using quadripolar leads with repetitive optimized LVPCs resulted in an additional increase in LVEF and reduction in LVESV and NYHA functional class at 6-month follow-up.
本研究旨在调查使用四极导线（QUAD）反复优化左心室起搏配置（LVPC）是否能改善心脏再同步治疗（CRT）的反应。
纳入52例符合条件的患者，并按1:1随机分为四极左心室导线（QUAD）组或传统双极导线（CONV）组。在QUAD组中，所有患者在出院前以及随访3个月时对无反应者进行LVPC优化。在CRT植入前、植入后3个月和6个月进行临床评估和经胸超声心动图检查。
在3个月随访时，CONV组25例患者中的16例（64%）（1例失访）和QUAD组26例患者中的18例（69%）被归类为反应者。在QUAD组中对3个月时无反应者的LVPC进行优化后，QUAD组26例患者中的21例（80.8%）在6个月时被归类为反应者，而CONV组25例患者中的17例（68%）为反应者。6个月时，QUAD组左心室收缩末期容积（LVESV）减少、左心室射血分数（LVEF）增加以及纽约心脏协会（NYHA）心功能分级降低均显著大于CONV组（LVESV：-26.9±13.8 vs -17.2±13.3%；P = 0.013；LVEF：+12.7±8.0 vs +7.8±6.3个百分点；P = 0.017；NYHA：-1.27±0.67 vs -0.72±0.54个心功能分级；P = 0.002）。
与传统双极导线相比，使用带有反复优化LVPC的四极导线进行CRT在6个月随访时可使LVEF进一步增加，LVESV和NYHA心功能分级进一步降低。
