Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Division of Cardiology, Durham VA Medical Center, Durham, NC, USA.
Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Division of Cardiology, Durham VA Medical Center, Durham, NC, USA.
J Electrocardiol. 2020 Sep-Oct;62:124-128. doi: 10.1016/j.jelectrocard.2020.08.012. Epub 2020 Aug 19.
Some patients with ongoing heart failure symptoms after treatment with cardiac resynchronization therapy (CRT) demonstrate QRS prolongation during exercise. We investigated whether the optimal CRT pacing configuration changes during dobutamine stress.
Seven patients undergoing CRT implantation underwent invasive LV dP/dT measurement during CRT pacing in 10 configurations to determine the optimal baseline pacing configuration (OPC). Measurements were repeated during dobutamine infusion. Differences in mean LV dP/dT between pacing configurations were compared.
Baseline OPC differed from stress OPC in 6/7 patients. The mean (SD) LV dP/dT obtained during dobutamine infusion was 1140 (377) mmHg/s in AAI pacing, 1458 (448) mmHg/s in the baseline OPC, and 1656 (435) mmHg/s in the dobutamine OPC (p < 0.001 for differences). The mean increase in LV dP/dT obtained by changing from baseline OPC to dobutamine OPC during dobutamine infusion was 197 (338) mmHg/s (13%). The QRS duration, QRS morphology, QLV and QRV intervals did not change significantly during dobutamine infusion (all P > 0.05).
The optimal CRT pacing configuration changes during dobutamine infusion while LV and RV activation timing does not. Further studies investigating the usefulness of automated dynamic changes to CRT pacing configuration according to physiologic condition may be warranted.
一些接受心脏再同步治疗（CRT）后仍有心衰症状的患者在运动时表现出 QRS 波延长。我们研究了在多巴酚丁胺应激期间是否改变了最佳 CRT 起搏配置。
7 名接受 CRT 植入的患者在 10 种起搏配置下进行 CRT 起搏时进行了左心室 dp/dt 测量，以确定最佳基线起搏配置（OPC）。在多巴酚丁胺输注期间重复测量。比较了不同起搏配置之间的平均左心室 dp/dt 差异。
6/7 名患者的基线 OPC 与应激 OPC 不同。在 AAI 起搏时，多巴酚丁胺输注期间获得的平均（SD）左心室 dp/dt 为 1140（377）mmHg/s，在基线 OPC 时为 1458（448）mmHg/s，在多巴酚丁胺 OPC 时为 1656（435）mmHg/s（差异均 p<0.001）。在多巴酚丁胺输注期间，从基线 OPC 改变为多巴酚丁胺 OPC 时，左心室 dp/dt 的平均增加量为 197（338）mmHg/s（13%）。在多巴酚丁胺输注期间，QRS 持续时间、QRS 形态、QLV 和 QRV 间隔没有明显变化（均 P>0.05）。
在多巴酚丁胺输注期间，最佳 CRT 起搏配置发生变化，而 LV 和 RV 激活时间不变。可能需要进一步研究根据生理状况自动动态改变 CRT 起搏配置的有用性。
