Jing Ran, Jin Han, Hua Wei, Yang Shengwen, Hu Yiran, Zhang Shu
The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Peking University First Hospital, Beijing, China.
Korean Circ J. 2020 Dec;50(12):1062-1073. doi: 10.4070/kcj.2019.0420. Epub 2020 Oct 7.
Preimplantation QRS-T morphology screening (TMS) is a composite tool for selecting subcutaneous implantable cardioverter defibrillator (S-ICD) candidates. However, its role in predicting the patient's response to cardiac resynchronization therapy (CRT) is uncertain.
A total of 55 consecutive de novo CRT candidates were enrolled between January 2016 and March 2017. Electrocardiogram (ECG) and TMS were performed before and soon after implantation. The ECG parameters were recorded, including QRS duration and morphology (such as ΔQRS_Index, QTc during biventricular pacing mode [BiV pacing QTc], and QRS/T ratio during biventricular pacing mode [BiV pacing QRS/T ratio]). TMS monitored three sensory vectors of the S-ICD. Six months after implantation, the responses to CRT were evaluated.
Thirty-nine patients (70.9%) passed the TMS during biventricular pacing mode. At the six-month follow-up, the number of responders and super-responders was significantly higher in the passing group than in the non-passing group (responders: 31/39 [79.5%] vs. 5/16 [31.3%], p<0.001; super-responders: 9/39 [23.1%] vs. 1/16 [6.3%], p=0.020). The super-response rate was higher among patients who passed all three vectors than among those who passed 1 or 2 vectors (3 vs. 2 vectors, p=0.018; 3 vs. 1 vector, p=0.003). A smaller left atrial diameter, vectors that passed TMS during biventricular pacing mode, and larger ΔQRS_Index values were independently associated with good CRT response.
Our study demonstrated that patients on CRT who pass the TMS during biventricular pacing mode are more likely to respond and super-respond to CRT.
植入前QRS-T形态学筛查（TMS）是一种用于选择皮下植入式心律转复除颤器（S-ICD）候选者的综合工具。然而，其在预测患者对心脏再同步治疗（CRT）反应方面的作用尚不确定。
2016年1月至2017年3月期间，共纳入55例连续的初诊CRT候选者。在植入前及植入后不久进行心电图（ECG）和TMS检查。记录ECG参数，包括QRS时限和形态（如ΔQRS_指数、双心室起搏模式下的QTc[双心室起搏QTc]以及双心室起搏模式下的QRS/T比值[双心室起搏QRS/T比值]）。TMS监测S-ICD的三个感知向量。植入后6个月，评估对CRT的反应。
39例患者（70.9%）在双心室起搏模式下通过了TMS。在6个月随访时，通过组的反应者和超级反应者数量显著高于未通过组（反应者：31/39[79.5%]对5/16[31.3%]，p<0.001；超级反应者：9/39[23.1%]对1/16[6.3%]，p=0.020）。通过所有三个向量的患者的超级反应率高于通过1个或2个向量的患者（3个向量对2个向量，p=0.018；3个向量对1个向量）。较小的左心房直径、在双心室起搏模式下通过TMS的向量以及较大的ΔQRS_指数值与良好的CRT反应独立相关。
我们的研究表明，在双心室起搏模式下通过TMS的CRT患者更有可能对CRT产生反应和超级反应。
