Rials Seth J, Pershing Michele, Collins Christy
OhioHealth Heart and Vascular Physicians, Division of Cardiology, Grant Medical Center, Columbus, OH, USA.
OhioHealth Research Institute, Columbus, OH, USA.
J Innov Card Rhythm Manag. 2018 Jan 15;9(1):2989-2995. doi: 10.19102/icrm.2018.090102. eCollection 2018 Jan.
The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRT). Prior studies have measured QLV from permanent pacing leads, or have used electroanatomic mapping systems. The current study compares QLV measurements made with a guidewire to those collected from permanent LV pacing leads positioned at the same venous site without the use of electroanatomic mapping systems. In this study, 20 patients undergoing CRT implantation (14 males, mean QRS: 164.0 ms) had QLV measurements taken using a guidewire. QLV and LV electrogram duration measurements were made at LV pacing sites, and were repeated after positioning the permanent LV pacing lead at the same site. There was no difference in QLV measurements obtained using a guidewire and those obtained using the permanent pacing lead placed at the same site (p = 0.569). QLV measurements obtained with a guidewire and the permanent LV pacing lead at the same site, respectively, were strongly correlated (r = 0.965; p < 0.001). The median absolute difference in electrogram duration was 7.0 ms (p = 0.55). The average time required to make QLV measurements using the guidewire was 11.7 minutes [standard deviation (SD): 6.8]. The average total fluoroscopy time for the entire CRT implant procedure was 10.9 minutes (SD: 5.1). In light of these results, it can be suggested that a guidewire can be used to prospectively measure LV prior to selection or placement of a permanent pacing lead without the use of an electroanatomic mapping system.
左心室（LV）起搏导线处局部激动的时间是从QRS波群起始点测量至左心室电图（QLV）的峰值。从激动延迟部位进行起搏与心脏再同步治疗（CRT）的较高反应率相关。既往研究已通过永久起搏导线测量QLV，或使用了电解剖标测系统。本研究比较了使用导丝进行的QLV测量与在不使用电解剖标测系统的情况下从位于相同静脉部位的永久左心室起搏导线收集的QLV测量结果。在本研究中，20例接受CRT植入的患者（14例男性，平均QRS波：164.0毫秒）使用导丝进行了QLV测量。在左心室起搏部位进行QLV和左心室电图持续时间测量，并在将永久左心室起搏导线置于同一部位后重复测量。使用导丝获得的QLV测量结果与使用置于同一部位的永久起搏导线获得的测量结果之间无差异（p = 0.569）。分别在同一部位使用导丝和永久左心室起搏导线获得的QLV测量结果高度相关（r = 0.965；p < 0.001）。电图持续时间的中位数绝对差异为7.0毫秒（p = 0.55）。使用导丝进行QLV测量所需的平均时间为11.7分钟[标准差（SD）：6.8]。整个CRT植入手术的平均总透视时间为10.9分钟（SD：5.1）。鉴于这些结果，可以认为在不使用电解剖标测系统的情况下，在选择或放置永久起搏导线之前，可使用导丝前瞻性地测量左心室。
