医学
左束支阻滞
心脏再同步化治疗
心脏病学
内科学
心电图
束支阻滞
捆绑
心力衰竭
射血分数
复合材料
材料科学
作者
Tsz-Kin Tam,Alex C. K. Au,Joseph Yat‐Sun Chan,Chin Pok Chan,Lily Cheung,Yuet-Wong Cheng,Fiona Yuen,Bryan P. Yan
标识
DOI:10.1016/j.hrthm.2024.02.027
摘要
Abstract:
Background
Heart failure patients with non-left bundle branch block (non-LBBB) QRS pattern have limited response rate to biventricular pacing (BVP). Objectives
A personalized cardiac resynchronization therapy (CRT) implantation approach guided by real-time electrocardiographic imaging (ECGi) was studied. Methods
Twenty patients with left ventricular ejection fraction (LVEF) ≤35%, QRS duration ≥120ms and non-LBBB (13 right bundle branch block and 7 intraventricular conduction delay) were recruited. During CRT implantation, right atrial, right ventricular, coronary sinus, His-bundle and/or Left-bundle leads were inserted. The total activation time (TAT) with different pacing combinations were measured real-time during implantation by ECGi. The configuration producing shortest TAT would be chosen. Clinical response was defined as ≥1 New York Heart Association (NYHA) class improvement. Echocardiographic response was defined as LV end systolic volume reduction ≥15% and/or LVEF improvement ≥10% at 6-months. Results
After ECGi guided CRT implantation, LVEF improved from 26±6% to 34±11% (both p<0.01) and NYHA class improved from 3.0±0.5 to 2.0±0.6 (p<0.01). Both clinical and echocardiographic response rates were 70%. ECGi approach resulted in better acute electrical resynchronization over BVP as measured by TAT reduction (40% vs 14%, p<0.01). Percentage of TAT reduction was found to be a strong predicator for echocardiographic response (AUC for ROC curve 0.91, 95% CI 0.78 – 1.00). A strong positive correlation between percentage TAT reduction and percentage LVEF improvement (Pearson R 0.70, p=0.001) was found. Conclusions
ECGi guided CRT implantation in non-LBBB patients generates superior acute electrical resynchronization compared with BVP and is associated with favorable clinical and echocardiographic outcomes.
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