三维电激动标测技术在CRT无反应扩张型心肌病患者治疗中的指导作用

发布时间：2018-11-16 14:29

【摘要】：目的观察三维电激动标测技术在心脏再同步化治疗(CRT)无反应扩张型心肌病患者治疗中的指导作用。方法选择CRT无反应的扩张型心肌病患者22例,均行三维电激动标测检查判断左室电激动最延迟部位;行冠状静脉窦逆行造影观察激动最延迟部位附近血管情况。17例激动最延迟部位附近有血管且无畸形,选择经冠状静脉窦途径植入左室导线;3例激动最延迟部位附近无血管、2例血管畸形,选择经房间隔或室间隔穿刺途径于激动最延迟部位植入左室心内膜导线。分别于手术前及术后1、3、6个月对患者心功能及左室同步性进行评价。结果术后1、3、6个月,22例患者心功能指标(纽约心脏病协会心功能分级、6 min步行距离、左室射血分数、二尖瓣反流程度、左室收缩末期容积)及左室同步性评价指标(室间机械延迟、左室内最晚收缩-最早收缩达峰时间、左室12节段达峰时间标准差)与术前比较,P均0.05;术后3个月与术后1个月比较,P均0.05;术后6个月与术后1、3个月比较,P均0.05。结论三维电激动标测技术可准确判断CRT无反应扩张型心肌病患者左室电激动最延迟部位,进而选择最佳途径植入左室导线,提高患者对CRT的反应性。
[Abstract]:Objective to observe the guiding effect of three dimensional electrokinetic mapping on cardiac resynchronization in patients with (CRT) nonreactive dilated cardiomyopathy. Methods Twenty-two patients with dilated cardiomyopathy without CRT were selected and the most delayed sites of left ventricular electrical stimulation were determined by three-dimensional electrokinetic mapping. Coronary sinus retrograde angiography was performed to observe the vascularity near the most delayed part of the coronary vein. In 17 cases, there was no malformation near the most delayed part, and the left ventricular lead was implanted through the approach of coronary sinus. In 3 cases, there was no blood vessel near the most delayed site, and 2 cases of vascular malformation. Transatrial septal or ventricular septal puncture was used to implant the left ventricular endocardial wire at the most delayed part of the agitation. Heart function and left ventricular synchrony were evaluated before operation and 1 and 6 months after operation. Results the cardiac function indexes of 22 patients (New York Heart Association cardiac function classification, 6 min walking distance, left ventricular ejection fraction, mitral regurgitation degree) were found 1 and 6 months after operation. The left ventricular end-systolic volume (LVEV) and left ventricular synchronism (LVL) were compared with those before operation (P < 0.05), including the left ventricular mechanical delay, the earliest peak systolic time and the left ventricular 12-segment peak time standard deviation. 3 months after operation compared with 1 month after operation, P 0.05, 6 months after operation compared with 1, 3 months after operation, P 0.05. Conclusion Three-dimensional electrokinetic mapping technique can accurately determine the most delayed site of left ventricular electrical stimulation in patients with CRT non-reactive dilated cardiomyopathy, and then select the best way to implant left ventricular conductors to improve the response of patients to CRT.
【作者单位】：安徽医科大学附属省立医院;
【基金】：安徽省科技攻关项目(1301042210)
【分类号】：R542.2

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