Dedinje Cardiovascular Institute, Heroja Milana Tepića 1, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2023 Dec 15;59(12):2178. doi: 10.3390/medicina59122178.
: Cardiac resynchronization therapy (CRT) is one of the effective therapeutic options in the treatment of systolic heart failure (HF) with persistent symptoms. This prospective study was designed to determine whether CRT with biventricular pacing would reduce the risk of development of atrial fibrillation (AF) and to identify predictors for AF occurrence. : The study population consisted of 126 patients, with a mean age of 63.8 ± 9.1 years, who were eligible for CRT with biventricular pacing. Inclusion criteria were left ventricular ejection fraction (LVEF) ≤ 35%, QRS duration ≥ 130 msec, and persistent HF symptoms of New York Heart Association (NYHA) II or III, despite optimal drug therapy. Patients were followed for a period of 24 months and were evaluated through clinical, electrocardiographic, and echocardiographic examination at baseline (prior to CRT implantation), as well as at 6 and 24 months post-implantation. At the end of follow-up, patients were divided into clinical responders and non-responders based on the following criteria: decrease in NYHA class ≥ I, increase in LVEF ≥ 10%, and reduction in QRS duration ≥ 20 msec. : At follow-up, CRT was associated with a significant increase in LVEF (20.6 ± 6.9% pre-implantation, 32.9 ± 9.3% 24 months after implantation; < 0.001), reduction in left ventricular end-diastolic and end-systolic diameters, and decrease in QRS duration (167.6 ± 14.3 msec pre-implantation, 131.7 ± 11.7 msec 24 months after implantation; < 0.001), while left atrial (LA) diameter was slightly increased ( = 0.070). The frequency of AF occurrence increased after two years of follow-up (52.4% to 56.9%, < 0.001). Significant predictors of AF occurrence in our study population were response to CRT-AF more frequent in non-responders (B = 8.134; < 0.001), LA diameter-AF more frequent with larger LA diameter (B = 0.813; < 0.001), and coronary sinus (CS) lead position-AF more frequent with posterolateral in comparison with lateral CS lead position (B = 5.159; = 0.005). : The results of our study provide new data on AF predictors in patients with HF subjected to CRT. There remains a permanent need for new predictors, which might help in patient selection and improvement in response rate.
心脏再同步治疗（CRT）是治疗射血分数降低的心力衰竭（HF）伴持续症状的有效治疗选择之一。本前瞻性研究旨在确定双心室起搏的 CRT 是否会降低心房颤动（AF）的发生风险，并确定 AF 发生的预测因素。
研究人群包括 126 名符合条件的患者，平均年龄为 63.8 ± 9.1 岁，接受双心室起搏的 CRT。入选标准为左心室射血分数（LVEF）≤35%，QRS 持续时间≥130ms，尽管接受了最佳药物治疗，但仍有纽约心脏协会（NYHA）II 或 III 级持续性 HF 症状。患者接受了 24 个月的随访，并在基线（CRT 植入前）、植入后 6 个月和 24 个月进行临床、心电图和超声心动图检查。在随访结束时，根据以下标准将患者分为临床反应者和无反应者：NYHA 分级至少降低 1 级，LVEF 至少增加 10%，QRS 持续时间至少减少 20ms。
随访时，CRT 与 LVEF 的显著增加相关（植入前 20.6 ± 6.9%，植入后 24 个月 32.9 ± 9.3%；<0.001），左心室舒张末期和收缩末期直径减小，QRS 持续时间缩短（植入前 167.6 ± 14.3ms，植入后 24 个月 131.7 ± 11.7ms；<0.001），而左心房（LA）直径略有增加（=0.070）。在两年的随访后，AF 的发生率增加（52.4%至 56.9%；<0.001）。在我们的研究人群中，AF 发生的显著预测因素包括 CRT-AF 在无反应者中更常见（B=8.134；<0.001），LA 直径-AF 在 LA 直径较大时更常见（B=0.813；<0.001），冠状窦（CS）导联位置-AF 在与侧 CS 导联位置相比，后外侧导联位置更常见（B=5.159；=0.005）。
我们的研究结果提供了 HF 患者接受 CRT 后 AF 预测因素的新数据。仍然需要新的预测因素，这可能有助于患者选择和提高反应率。
