The Intervention Centre, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Europace. 2023 Mar 30;25(3):1183-1192. doi: 10.1093/europace/euad013.
Successful cardiac resynchronization therapy (CRT) shortens the pre-ejection period (PEP) which is prolonged in the left bundle branch block (LBBB). In a combined animal and patient study, we investigated if changes in the pulse arrival time (PAT) could be used to measure acute changes in PEP during CRT implantation and hence be used to evaluate acute CRT response non-invasively and in real time.
In six canines, a pulse transducer was attached to a lower limb and PAT was measured together with left ventricular (LV) pressure by micromanometer at baseline, after induction of LBBB and during biventricular pacing. Time-to-peak LV dP/dt (Td) was used as a surrogate for PEP. In twelve LBBB patients during implantation of CRT, LV and femoral pressures were measured at baseline and during five different pacing configurations. PAT increased from baseline (277 ± 9 ms) to LBBB (313 ± 16 ms, P < 0.05) and shortened with biventricular pacing (290 ± 16 ms, P < 0.05) in animals. There was a strong relationship between changes in PAT and Td in patients (r2 = 0.91). Two patients were classified as non-responders at 6 months follow-up. CRT decreased PAT from 320 ± 41 to 298 ± 39 ms (P < 0.05) in the responders, while PAT increased by 5 and 8 ms in the two non-responders.
This proof-of-concept study indicates that PAT can be used as a simple, non-invasive method to assess the acute effects of CRT in real time with the potential to identify long-term response in patients.
成功的心脏再同步治疗（CRT）可缩短左束支传导阻滞（LBBB）时延长的射血前期（PEP）。在一项联合动物和患者的研究中，我们研究了脉搏到达时间（PAT）的变化是否可用于测量 CRT 植入过程中 PEP 的急性变化，从而用于实时无创评估急性 CRT 反应。
在 6 只犬中，将脉搏传感器连接到下肢，通过微测压计同时测量 PAT 和左心室（LV）压力，在基线、诱导 LBBB 和双心室起搏时进行测量。LV 最大 dp/dt 时间（Td）被用作 PEP 的替代指标。在 12 例 LBBB 患者 CRT 植入过程中，在基线和 5 种不同起搏配置下测量 LV 和股动脉压力。PAT 从基线（277 ± 9 ms）增加到 LBBB（313 ± 16 ms，P < 0.05），并随双心室起搏而缩短（290 ± 16 ms，P < 0.05）。在患者中，PAT 变化与 Td 之间存在很强的相关性（r2 = 0.91）。2 例患者在 6 个月随访时被归类为无反应者。CRT 使反应者的 PAT 从 320 ± 41 降至 298 ± 39 ms（P < 0.05），而在 2 例无反应者中 PAT 分别增加了 5 和 8 ms。
这项概念验证研究表明，PAT 可用作一种简单、无创的方法，实时评估 CRT 的急性效应，并有潜力识别患者的长期反应。
