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目的探讨单左室起搏(LUVP)逐跳跟踪生理性房室延迟(AVD)实现心脏再同步化治疗(CRT)的可行性及其算法。方法入选符合CRTⅠ类适应证并植入三腔起搏器的慢性充血性心力衰竭患者34例,术前动态心电图采集房性早搏。心脏超声下优化AVD及V-V间期,测定LUVP脉冲到右室腔内图起始(LVP-RV)的间期及LUVP需优先于右室的间期(V-R间期),比较两间期的差异并计算左室优先系数(ε),比较LUVP与标准双室起搏(BVP)两种模式的心脏超声指标及QRS波时限差异,测定并比较1min内两个相邻窦性心跳间及最大与最小ASVS间期差异,建立LUVP逐跳跟踪生理性AVD实现CRT的算法。结果房性早搏的生理性AVD的回归方程为:P′R′=0.022+0.954PR,除左室射血分数及左室十二节段达峰时间标准差两种模式比较无差异外(P>0.05),二尖瓣返流面积、主动脉瓣前向血流速度时间积分、心室间机械延迟时间、QRS波时限LUVP均较BVP改善(P<0.01或0.05)。LVP-RV间期(103±16)ms明显大于V-R间期[(20.2±7.0)ms,P<0.01]。ε为0.72±0.03。1min内相邻两个窦性心跳AS-VS间期的最大差值(6.47±1.62)ms明显小于最大与最小AS-VS间期的差值[(16.24±3.29)ms,P<0.01]。结论 LUVP逐跳跟踪生理性房室延迟可实现CRT。
Objective To investigate the feasibility and algorithm of cardiac resynchronization therapy (CRT) by single ventricular pacing (LVDP) followed by atrioventricular delay (AVD). Methods Thirty-four patients with chronic congestive heart failure who were eligible for CRT class I and implanted with three-chamber pacemaker were enrolled in this study. Atrial premature beats were collected preoperatively. The AVD and VV interval were optimized under echocardiography. The interval between LUVP pulse and LVP-RV and the interval between LUVP and right ventricle (VR interval) were determined. (Ε) was calculated and compared between the two modes of LUVP and BVP. The difference of QRS time and heart rate between two groups was measured and compared. The two adjacent sinus beats and the maximum And the minimum interval between ASVS differences, the establishment of LUVP hop-by-hop physiological AVD CRT algorithm. Results The regression equation of physiological AVD in atrial premature beats was: P’R ’= 0.022 + 0.954PR. Except for the difference of left ventricular ejection fraction and standard deviation of peak time of twelve segments in left ventricular, there was no significant difference (P> 0.05 ), Mitral valve regurgitation area, aortic valve forward flow velocity time integral, ventricular mechanical delay time and QRS wave limit LUVP were significantly improved compared with BVP (P <0.01 or 0.05). LVP-RV interval (103 ± 16) ms was significantly greater than the V-R interval [(20.2 ± 7.0) ms, P <0.01]. The maximum difference (6.47 ± 1.62) ms between two consecutive AS-VS intervals of sinus beats was significantly smaller than the difference between maximum and minimum AS-VS intervals [(16.24 ± 3.29) ms , P <0.01]. Conclusions LUVP can be used to track CRT by hopping physiological atrioventricular delay.