动态房室延迟程控可改善心室电同步性，三维向量心电图评估结果显示如此。
Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography.
作者信息
Engels Elien B, Thibault Bernard, Mangual Jan, Badie Nima, McSpadden Luke C, Calò Leonardo, Ritter Philippe, Pappone Carlo, Bode Kerstin, Varma Niraj, Prinzen Frits W
机构信息
Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Medicine, University of Western Ontario, London, Ontario, Canada.
Electrophysiology Service, Montreal Heart Institute, Montreal, Canada.
出版信息
J Electrocardiol. 2020 Jan-Feb;58:1-6. doi: 10.1016/j.jelectrocard.2019.09.026. Epub 2019 Oct 20.
BACKGROUND
Optimal timing of the atrioventricular delay in cardiac resynchronization therapy (CRT) can improve synchrony in patients suffering from heart failure. The purpose of this study was to evaluate the impact of SyncAV™ on electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics during bi-ventricular (BiV) pacing.
METHODS
Patients implanted with a cardiac resynchronization therapy (CRT) device and quadripolar left ventricular (LV) lead underwent 12‑lead ECG recordings. VCG metrics, including QRS duration (QRSd) and area, were derived from the ECG by a blinded observer during: intrinsic conduction, BiV with nominal atrioventricular delays (BiV Nominal), and BiV with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).
RESULTS
One hundred patients (71% male, 40% ischemic, 65% LBBB, 32 ± 9% ejection fraction) completed VCG assessment. QRSd during intrinsic conduction (166 ± 25 ms) was narrowed successively by BiV Nominal (137 ± 23 ms, p < .05 vs. intrinsic) and BiV + SyncAV Opt (122 ± 22 ms, p < .05 vs. BiV Nominal). Likewise, 3D QRS area during intrinsic conduction (90 ± 42 mV ∗ ms) was reduced by BiV Nominal (65 ± 39 mV ∗ ms, p < .05 vs. intrinsic) and further by BiV + SyncAV Opt (53 ± 30 mV ∗ ms, p = .06 vs. BiV Nominal).
CONCLUSION
With VCG-based, patient-specific optimization of the programmable offset, SyncAV reduced electrical dyssynchrony beyond conventional CRT.
背景
心脏再同步治疗（CRT）中房室延迟的最佳时机可改善心力衰竭患者的同步性。本研究的目的是评估SyncAV™对双心室（BiV）起搏期间通过矢量心电图（VCG）得出的QRS指标所测量的电同步性的影响。
方法
植入心脏再同步治疗（CRT）设备和四极左心室（LV）导线的患者进行了12导联心电图记录。在以下期间，由一名不知情的观察者从心电图中得出VCG指标，包括QRS时限（QRSd）和面积：自身传导、具有标称房室延迟的双心室起搏（BiV标称），以及将SyncAV编程为实现最大同步的最佳偏移量的双心室起搏（BiV + SyncAV最佳）。
结果
100例患者（71%为男性，40%为缺血性，65%为左束支传导阻滞，射血分数为32±9%）完成了VCG评估。自身传导期间的QRSd（166±25毫秒）在BiV标称时依次变窄（137±23毫秒，与自身传导相比p<0.05），在BiV + SyncAV最佳时进一步变窄（122±22毫秒，与BiV标称相比p<0.05）。同样，自身传导期间的三维QRS面积（90±42毫伏毫秒）在BiV标称时减小（65±39毫伏毫秒，与自身传导相比p<0.05），在BiV + SyncAV最佳时进一步减小（53±30毫伏*毫秒，与BiV标称相比p = 0.06）。
结论
通过基于VCG的、针对患者的可编程偏移量优化，SyncAV减少了传统CRT之外的电不同步。
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