Center for Arrhythmia Care, Section of Cardiology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA.
Curr Cardiol Rep. 2017 Oct 24;19(12):125. doi: 10.1007/s11886-017-0929-8.
We sought to assess the utility of CRT in patients with non-LBBB.
CRT has an established role as a device-based therapy for patients with HF with systolic dysfunction and intraventricular conduction disease, specifically LBBB. In modern practice, the use of CRT in non-LBBB patients remains controversial, with high rates of non-response for CRT in patients with RBBB, in particular. Recent studies have identified sub-populations of non-LBBB patients that respond to resynchronization, such as those with prolonged PR intervals (≥ 230 ms), with RBBB and concomitant left-sided delay and those with significant burden of right ventricular pacing. As technology has advanced to allow for detailed mapping of LV electrical and mechanical function, benefits have been found with placement of LV leads utilizing intra-procedural mapping to target areas of greatest electrical activation delay or mechanical dyssynchrony, leading to more widespread benefit through the more specific application of CRT.
我们旨在评估 CRT 在非 LBBB 患者中的应用价值。
CRT 已作为一种基于器械的治疗方法，广泛应用于心衰伴收缩功能障碍和室内传导疾病患者，特别是 LBBB 患者。在现代实践中，CRT 在非 LBBB 患者中的应用仍存在争议，尤其是 RBBB 患者的 CRT 反应率较高。最近的研究已经确定了对再同步有反应的非 LBBB 患者亚群，例如 PR 间期延长（≥230ms）、RBBB 并伴有左侧延迟以及右心室起搏负担较重的患者。随着技术的进步，能够对 LV 电和机械功能进行详细的映射，利用术中映射将 LV 导线放置在具有最大电激活延迟或机械不同步的区域，可以获得更多的益处，从而通过更具体地应用 CRT 获得更广泛的益处。
