Fusion-Optimized Intervals ( FOI): A New Method to Achieve the Narrowest QRS for Optimization of the AV and VV Intervals in Patients Undergoing Cardiac Resynchronization Therapy
Fusion-Optimized Intervals ( FOI): A New Method to Achieve the Narrowest QRS for Optimization of the AV and VV Intervals in Patients Undergoing Cardiac Resynchronization Therapy
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DOI：
10.1111/jce.12322
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发表时间：
2014-03-01
影响因子：
2.7
通讯作者：
Mont, Lluis
中科院分区：
文献类型：
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作者：
Arbelo, Elena;Maria Tolosana, Jose;Mont, Lluis
基于qrs的心脏再同步化优化研究背景优化房室间隔（AV）和室间间隔（VV）可以改善心脏再同步化治疗（CRT）的反应，但这是一项复杂的任务。融合与本征传导可以增加CRT的效益。目的是描述一种基于QRS持续时间优化CRT的新方法——融合优化间隔（FOI）。方法与结果前瞻性纳入76例连续接受CRT的房颤传导保留患者。通过搜索左室起搏时融合带内获得的最窄QRS，优化房室间期。然后调整心室间隔，比较双室同步、左室预兴奋（-30毫秒）、右室（RV）预兴奋（-30毫秒）和左室仅起搏时QRS持续时间。一项针对31例患者的亚研究评估了有创性LV+dP/dt（max）。最佳融合优化房室间隔在心房感应时为136 30ms，在心房起搏时为192 +/- 35ms。同时双心室起搏28例（37%），左室预激22例（29%），仅左室20例（26%），左室预激6例（8%）。FOI（59 +/- 19毫秒）比名义设置（40 +/- 21毫秒；P < 0.001）更能缩短基线QRS。65例患者（86%）显示FOI使基线QRS缩短约10%；与标称设置相比，没有通过FOI延长QRS持续时间。所有超声心动图非同步参数均经FOI校正。基线+dP/dt（max）改善在FOI （127 +/- 95 mmHg/秒）大于标称设置（102 +/- 71 mmHg/秒；P= 0.05）。结论与常规CRT相比，FOI方法可行，可进一步缩短QRS持续时间，改善急性血流动力学反应。
QRS-Based Optimization of Cardiac ResynchronizationBackgroundOptimization of atrioventricular (AV) and interventricular (VV) intervals may improve cardiac resynchronization therapy (CRT) response but is a complex task. Fusion with intrinsic conduction may increase the benefit of CRT. The aim was to describe fusion-optimized intervals (FOI), a new method of optimizing CRT based on QRS duration.Methods and ResultsSeventy-six consecutive patients with preserved AV conduction who received CRT were prospectively included. The AV interval was optimized by searching the narrowest QRS obtained within the fusion band during left ventricular (LV) pacing. The VV interval was then adjusted, comparing QRS duration in simultaneous biventricular, LV preexcitation (-30milliseconds), right ventricular (RV) preexcitation (-30milliseconds) and LV-only pacing. A substudy in 31 patients evaluated the invasive LV+dP/dt(max). The best fusion-optimized AV interval was 136 30milliseconds during atrial sensing and 192 +/- 35milliseconds during atrial pacing. The best QRS was obtained with simultaneous biventricular pacing in 28 patients (37%), LV preexcitation in 22 (29%), LV-only in 20 (26%), and RV preexcitation in 6 (8%). Baseline QRS was shortened more by FOI (59 +/- 19milliseconds) than by nominal settings (40 +/- 21milliseconds; P < 0.001). Sixty-five patients (86%) showed >10% shortening of the baseline QRS with FOI; none prolonged the QRS duration by FOI compared to nominal settings. All echocardiographic asynchrony parameters were corrected by FOI. Baseline+dP/dt(max) improvement was greater in FOI (127 +/- 95 mmHg/seconds) than in nominal settings (102 +/- 71 mmHg/seconds; P= 0.05).ConclusionThe FOI method is feasible, further reduces QRS duration, and improves acute hemodynamic response compared to nominal programming of CRT.