Rai Maneesh K, Prabhu Mukund A, Sharma Abhishek, Vekariya Ritesh, Kamath Padmanabh, Pai Narasimha, Kamath Ramanath L
Department of Cardiology, Kasturba Medical College, Mangalore, Karnataka, India.
Department of Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Indian Pacing Electrophysiol J. 2017 May-Jun;17(3):72-77. doi: 10.1016/j.ipej.2017.05.001. Epub 2017 May 6.
Cardiac Resynchronization therapy (CRT) remains largely under-used in developing countries owing to the high cost of therapy. In this pilot study, we explore 'optimized' Left Ventricle Only Pacing (LVOP) as a cost effective alternative to cardiac resynchronization therapy in selected patients with heart failure.
In economically poorer patients with heart failure, left bundle branch block (LBBB) and intact AV node conduction, synchronization can be obtained using a dual chamber pacemaker (leads in right atrium and Left ventricle) with the help of 2D strain imaging.
4 patients underwent LVOP for symptomatic heart failure. Post procedure 'optimization' was done using 12 lead electrocardiography and 2D- Strain imaging. Difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff T) was calculated for each segment at different AV delays and the AV delay with the smallest Diff T was programmed. The mean AV delay that resulted in electrical and mechanical synchrony was 150 ms. After a mean follow up of 6 months, all patients had improved by at least 1 NYHA class. The mean reduction in QRS duration post procedure was -54.5 ± 22.82 ms and the mean improvement in EF was 7 ± 2.75%.
Optimized LVOP using 2D strain and ECG can be a cost-effective alternative to CRT in patients with LBBB, heart failure and normal AV node conduction.
由于治疗费用高昂，心脏再同步治疗（CRT）在发展中国家的应用仍非常有限。在这项初步研究中，我们探索“优化”的单纯左心室起搏（LVOP）作为某些心力衰竭患者心脏再同步治疗的一种经济有效的替代方法。
在经济条件较差、患有心力衰竭、存在左束支传导阻滞（LBBB）且房室结传导正常的患者中，借助二维应变成像，使用双腔起搏器（导线置于右心房和左心室）可实现同步。
4例有症状心力衰竭患者接受了LVOP治疗。术后使用12导联心电图和二维应变成像进行“优化”。计算不同房室延迟时各节段达到纵向应变峰值的时间与主动脉瓣关闭时间之差（Diff T），并设定Diff T最小的房室延迟。实现电和机械同步的平均房室延迟为150毫秒。平均随访6个月后，所有患者的纽约心脏协会（NYHA）心功能分级至少改善1级。术后QRS时限平均缩短-54.5±22.82毫秒，射血分数（EF）平均改善7±2.75%。
对于患有LBBB、心力衰竭且房室结传导正常的患者，使用二维应变和心电图进行优化的LVOP可作为CRT的一种经济有效的替代方法。
