Presidente Perón Hospital, Buenos Aires, Argentina; Seventh Day Adventist Clinic, Buenos Aires, Argentina; Santa Isabel Clinic, Buenos Aires, Argentina.
Imbanaco Medical Center, Cali, Colombia.
Heart Rhythm. 2019 Oct;16(10):1453-1461. doi: 10.1016/j.hrthm.2019.07.017. Epub 2019 Jul 16.
Endocardial cardiac resynchronization therapy (eCRT) avoids the limitations and failures of coronary sinus (CS) resynchronization. However, data regarding long-term outcomes are lacking.
The purpose of this study was to report the long-term outcome of eCRT performed using the Jurdham procedure in a real-world setting.
eCRT was performed in patients who failed a CS implant or failed to respond to cardiac resynchronization therapy (CRT), or in selected patients requiring lifelong oral anticoagulation (OAC). Left ventricular ejection fraction (LVEF), New York Heart Association functional class (NYHA FC), and left ventricular stimulation parameters were assessed during long-term follow-up (FU).
From August 2009 to March 2018, the Jurdham procedure was performed in 88 patients at 15 centers in 8 countries, with FU of 32.88 ± 61.52 months (range 0-88 months; 196 patient-years). NYHA FC improved from 2.9 preimplant to 1.3 during FU. LVEF increased <10 percentage points from baseline in 7% of patients, between 10 and 20 percentage points in 11% of patients, and >20 percentage points in 82% of patients. All-cause mortality at 60 months was 30.5%. Three transient ischemic attacks (1.53 per 100 patient-years) and 6 strokes (3.06 per 100 patient-years) occurred. Of the 6 patients with stroke, 4 (66%) had almost complete recovery.
eCRT using the Jurdham procedure is an effective and safe technique in anticoagulated patients. This approach may be an attractive option for patients with failed CS implants or nonresponders to CS CRT. In addition, it might be a reasonable approach as a first option for treatment of patients requiring lifelong OAC.
心内膜心脏再同步治疗（eCRT）避免了冠状窦（CS）再同步的局限性和失败。然而，缺乏关于长期结果的数据。
本研究旨在报告在真实环境中使用 Jurdam 手术进行 eCRT 的长期结果。
在 CS 植入失败或对心脏再同步治疗（CRT）无反应的患者中，或在需要终身口服抗凝治疗（OAC）的选定患者中进行 eCRT。在长期随访（FU）期间评估左心室射血分数（LVEF）、纽约心脏协会功能分级（NYHA FC）和左心室刺激参数。
从 2009 年 8 月至 2018 年 3 月，在 8 个国家的 15 个中心对 88 例患者进行了 Jurdam 手术，FU 为 32.88±61.52 个月（范围 0-88 个月；196 例患者年）。NYHA FC 在 FU 期间从植入前的 2.9 改善至 1.3。7%的患者基线 LVEF 增加<10 个百分点，11%的患者增加 10-20 个百分点，82%的患者增加>20 个百分点。60 个月时全因死亡率为 30.5%。发生 3 例短暂性脑缺血发作（1.53/100 患者年）和 6 例中风（3.06/100 患者年）。6 例中风患者中，4 例（66%）几乎完全恢复。
使用 Jurdam 手术的 eCRT 是一种在抗凝患者中有效且安全的技术。这种方法可能是 CS 植入失败或 CS CRT 无反应患者的一个有吸引力的选择。此外，对于需要终身 OAC 的患者，它可能是一种合理的首选治疗方法。
