Effect of cardiac resynchronization therapy on ventricular repolarization in recent and long-term
-
摘要: 目的:探讨心脏再同步化治疗对心肌复极的近期及远期影响。方法:28例难治性心力衰竭患者行心脏再同步化治疗 (CRT) 后定期随访。6个月左室收缩末期容积 (LVESV) 降低 ≥ 15%为有反应者。以常规体表12导联心电图T波顶点至T波终点 (Tpeak-end) 间期作为心室复极异质性的指标。于CRT术后1周、第6及第12个月, 分别在右室、左室及双室3种不同起搏模式下测量心肌复极指标。结果:Tpeak-end在右室起搏时最小, 左室起搏时最大, 双室起搏与右室起搏之间没有统计学差异;CRT治疗6个月后有反应者较无反应者Tpeak-end明显减少[Lvepi:(100.15±6.30) ms:(139.13±5.91) ms, P<0.01], 并且随着时间延长, 心室复极异质性指标逐渐变小。结论:CRT治疗左室起搏明显增加心室复极异质性指标, 有反应者可以明显改善心室复极异质性。Abstract: Objective: To explore the effect of cardiac resynchronization therapy (CRT) on ventricular repolarization in recent and long term.Method: Twenty-eight patients with refractory heart failure fulfilled the CRT intervention.After being carried out the CRT treatment, All patients were regularly followed up.The regular body surface 12lead electrocardiogram Tpeak-end interval was used as indexes to evaluate the ventricular repolarization change, and were measured under the left ventricular pacing, right ventricular pacing and bi-ventricular pacing mode after operation 1week, 6th month and 12th month.Result: Tpeak-end interval under right ventricular pacing were the smallest among the 3situations, while left ventricular pacing was the largest situation, and there was no statstical difference between right ventricular pacing and bi-ventricular pacing.After the CRT treatment, compared with the no-response group, Tpeak-end in the response group improved noticeably[Lvepi:(100.15±6.30) ms vs (139.13±5.91) ms, P<0.01], and were getting smaller and smaller with time.Conclusion: CRT treatment can significantly increase the heterogeneity of ventricular repolarization in left ventricular pacing situation.The indexes of heterogeneity of ventricular repolarization can improve in response patients.
-
-
[1] FISH J M, BRUGADA J, ANTZELEVITCH C.Potential proarrhythmic effects of biventricular pacing[J].J Am Coll Cardiol, 2005, 46:2340-2347.
[2] 白融, 王晨, 杨晓云, 等.不同起搏部位对正常人体心肌复极离散的影响[J].临床心血管病杂志, 2004, 20 (4):142-145.
[3] NAYAK H M, VERDINO R J, RUSSO A M, et al.Ventricular tachycardia storm after initiation of biventricular pacing:incidence, clinical characteristics, management, and outcome[J].J Cardiovasc Electrophysiol, 2008, 19:708-715.
[4] IYOH M, YOSHIDA A, TAKEI A, et al.Electrical storm after cardiac resynchronization therapy suppressed by triple-site biventricular pacing and atrioventricular nodal ablation[J].Heart Rhythm, 2012, 9:2059-2062.
[5] BIASE L, GASPARINI M, LUNATI M, et al.Antiarrhythmic effect of reverse ventricular remodeling induced by cardiac resynchronization therapy:the InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry[J].J Am Coll Cardiol, 2008, 52:1442-1449.
[6] THIJSSEN J, BORLEFFS C J W, DELGADO V, et al.Implantable cardioverter-defibrillator patients who are upgraded and respond to cardiac resynchronization therapy have less ventricular arrhythmias compared with nonresponders[J].J Am Coll Cardiol, 2011, 58:2282-2289.
[7] BARSHESHET A, WANG P J, MOSS A J, et al.Reverse remodeling and the risk of ventricular tachyarrhythmias in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)[J].J Am Coll Cardiol, 2011, 57:2416-2423.
[8] LELLOUCHE N, DEDIEGO C, BOYLE N G, et al.Relationship between mechanical and electrical remodelling in patients with cardiac resynchronization implanted defibrillators[J].Europace, 2011, 13:1180-1187.
[9] GOLD M R, LINDE C, ABRAHAM W T, et al.The impact of cardiac resynchronization therapy on the incidence of ventricular arrhythmias in mild heart failure[J].Heart Rhythm, 2011, 8:679-684.
[10] CHAKIR K, DAYA S K, TUNIN R S, et al.Reversal of global apoptosis and regional stress kinase activation by cardiac resynchronization[J].Circulation, 2008, 117:1369-1377.
[11] BARTH A S, AIBA T, HALPERIN V, et al.Cardiac resynchronization therapy corrects dyssynchronyinduced regional gene expression changes on a genomic level[J].Circ Cardiovasc Genet, 2009, 2:371-378.
-
计量
- 文章访问数: 33
- PDF下载数: 14
- 施引文献: 0
下载: