Department of Cardiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230000, China.
Department of Electrocardiogram, Anhui Institute of Cardiovascular Diseases, Hefei, Anhui 230000, China.
Chin Med J (Engl). 2018 Oct 20;131(20):2402-2409. doi: 10.4103/0366-6999.243560.
The influence of different right ventricular lead locations on ventricular arrhythmias (VTA) in patients with a cardiac resynchronization therapy (CRT) is not clear. This study aimed to evaluate the influence on VTA in patients with a CRT when right ventricular lead was positioned at the right ventricular middle septum (RVMS) and the right ventricular apical (RVA).
A total of 352 patients implanted with a CRT-defibrillator (CRT-D) between May 2012 and July 2016 in the Department of Cardiology of Anhui Provincial Hospital were included. Two-year clinical and pacemaker follow-up data were collected to evaluate the influence of the right ventricular lead location on VTA. Patients were divided into the RVMS group (n = 155) and the RVA group (n = 197) based on the right ventricular lead position. The VTA were compared between these two groups using a Kaplan-Meier curve and Cox multivariate analysis.
When the left ventricular lead location was not considered, RVMS and RVA locations did not affect VTA. However, the subgroup analysis results showed that when the left ventricular lead was positioned at the anterolateral cardiac vein (ALCV), the RVMS group had an increased risk of ventricular arrhythmias and appropriate defibrillation (hazard ratio [HR] = 3.29, P = 0.01 and HR = 4.33, P < 0.01, respectively); when the left ventricular lead was at the posterolateral cardiac vein (PLCV), these risks in the RVMS group decreased (HR = 0.45, P = 0.02 and HR = 0.33, P < 0.01, respectively), and when the left ventricular lead was at the lateral cardiac vein, there was no difference between the two groups. In regard to inappropriate defibrillation, there was no significant difference among all these groups.
When the left ventricular lead was positioned at ALCV or PLCV, the right ventricular lead location was associated with VTA and appropriate defibrillation after CRT. Greater distances between leads not only improved cardiac function but also may reduce the risk of VTA.
右心室起搏导线位置不同对心脏再同步治疗（CRT）患者室性心律失常（VTA）的影响尚不清楚。本研究旨在评估右心室起搏导线位于右心室中隔（RVMS）和右心室心尖（RVA）时对 CRT 患者 VTA 的影响。
选取 2012 年 5 月至 2016 年 7 月在安徽省立医院心内科植入 CRT-除颤器（CRT-D）的 352 例患者，收集 2 年的临床和起搏器随访资料，评估右心室起搏导线位置对 VTA 的影响。根据右心室起搏导线位置将患者分为 RVMS 组（n = 155）和 RVA 组（n = 197）。采用 Kaplan-Meier 曲线和 Cox 多因素分析比较两组 VTA 。
不考虑左心室起搏导线位置时，RVMS 和 RVA 位置不影响 VTA。但是，亚组分析结果显示，当左心室起搏导线位于前外侧心静脉（ALCV）时，RVMS 组室性心律失常和适当除颤的风险增加（风险比[HR] = 3.29，P = 0.01 和 HR = 4.33，P < 0.01）；当左心室起搏导线位于后外侧心静脉（PLCV）时，RVMS 组的这些风险降低（HR = 0.45，P = 0.02 和 HR = 0.33，P < 0.01），当左心室起搏导线位于心侧静脉时，两组之间没有差异。对于不适当的除颤，所有这些组之间没有显著差异。
当左心室起搏导线位于 ALCV 或 PLCV 时，右心室起搏导线位置与 CRT 后 VTA 和适当除颤有关。导联之间的距离越大不仅改善心功能，而且可能降低 VTA 的风险。
