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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Larger interventricular conduction time enhances mechanical response to resynchronization therapy
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Larger interventricular conduction time enhances mechanical response to resynchronization therapy

机译：较大的心室传导时间可增强对再同步治疗的机械反应

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Background Previous studies have reported that the left ventricular (LV) pacing site is a major determinant of the hemodynamic response to cardiac resynchronization therapy (CRT). However, lead positioning in a lateral or posterolateral cardiac vein may not be optimal for every patient. The objective of this study was to assess the relationship between the right ventricular (RV)-to-LV conduction time and the systolic function during CRT on the basis of changes to LV pressure-volume loops. Methods Left ventricular pressure and volume data were determined using a conductance catheter during CRT device implantation in 10 patients. Four endocardial LV sites were systematically assessed at four atrioventricular delays. The RV-to-LV conduction time was measured as the time interval between spontaneous peak R waves, recorded through the RV lead and the LV catheter. Results The optimal pacing site varied among patients. However, the pacing site associated with the maximum RV-to-LV conduction time resulted in a stroke volume improvement comparable to the pacing site identified through individual hemodynamic optimization (41 ± 17 mL vs 44 ± 18 mL, P = 0.266). Moreover, the RV-to-LV conduction time recorded at each endocardial pacing site correlated positively with the increase in stroke volume (r = 0.537; P < 0.001), stroke work (r = 0.642; P < 0.001), and the pressure-derivative maximum (r = 0.646; P < 0.001) obtained with CRT. Conclusions An optimal acute response to CRT can be obtained by positioning the LV lead at the site associated with the maximum RV-to-LV conduction time. A significant correlation appears to exist between RV-to-LV conduction time and the improvement in systolic function with CRT.
机译：背景技术先前的研究报道说，左心室（LV）起搏部位是对心脏再同步治疗（CRT）的血液动力学反应的主要决定因素。然而，将导线放置在心脏外侧或后外侧的静脉中可能并非对每个患者都是最佳的。这项研究的目的是评估左心室（RV）到左心室传导时间与CRT期间收缩功能之间的关系，该变化基于左心室压力-容量环的变化。方法对10例CRT装置植入期间使用电导导管测定左室压力和体积数据。在四个房室延迟时系统地评估了四个心内膜LV部位。 RV到LV的传导时间是通过RV导线和LV导管记录的自发峰值R波之间的时间间隔测量的。结果最佳起搏部位因患者而异。但是，与最大RV到LV传导时间相关的起搏部位导致的卒中体积改善与通过单独的血液动力学优化确定的起搏部位相当（41±17 mL对44±18 mL，P = 0.266）。此外，在每个心内膜起搏部位记录的RV到LV的传导时间与中风量（r = 0.537; P <0.001），中风功（r = 0.642; P <0.001）和压力的增加呈正相关。 CRT获得的最大导数（r = 0.646; P <0.001）。结论通过将LV导线放置在与RV到LV的最大传导时间相关的位置，可以获得对CRT的最佳急性反应。 RV到LV的传导时间与CRT对收缩功能的改善之间似乎存在显着相关性。

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