Evaluating the response to cardiac resynchronization therapy performed with a new ventricular morphology-based strategy for congenital heart disease.
Evaluating the response to cardiac resynchronization therapy performed with a new ventricular morphology-based strategy for congenital heart disease.
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评估采用基于心室形态的新策略对先天性心脏病进行心脏再同步治疗的反应。
DOI：
10.1007/s00380-019-01369-2
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发表时间：
2019
影响因子：
1.5
通讯作者：
Hideo Ohuchi
中科院分区：
文献类型：
--
作者：
Aya Miyazaki;Jun Negishi;Yosuke Hayama;Shigehito Baba;Yu Matsumura;Yuriko Shima;Etusko Tsuda;Heima Sakaguchi;Takaya Hoashi;Koji Kagisaki;Takashi Noda;Hiraku Doi;Hajime Ichikawa;Hideo Ohuchi
背景在对先天性心脏病（CHD）和心室形态不同于全身性左心室（LV）的患者进行心脏起搏治疗（CRT）时，我们先前提出了不同于全身性LV的起搏部位。对于具有短轴不同步和单心室生理学双心室的患者，电极导线应横向放置在两个心室的对侧，而对于具有右心室（RV）长轴不同步的患者，电极导线应放置在右心室（RV）纵向沿着最远的部位。此外，对于室间不同步和双心室生理学伴系统性RV的患者，应将其放置在两个心室可以同时收缩的部位。我们回顾性研究了24例接受CRT的CHD患者的27例连续手术，以评估基于心室形态学的新CRT策略的有效性。有效率为63%（17/27）。10例患者对CRT无反应的原因如下：CRT期间电极导线位置不佳，4例; CRT前无全身心室传导延迟或心力衰竭症状，5例; CRT后随访时间短，2例;以及全身RV极度扩张，1例。排除无心室传导延迟或心力衰竭症状的手术和非最佳电极导线位置的手术后，应答率为88%（14/16）。这种新的CRT策略可以为伴有全身心室传导延迟和心力衰竭的CHD患者提供有利的结果。
BackgroundIn cardiac resynchronization therapy (CRT) for patients with congenital heart disease (CHD) and a ventricular morphology other than a systemic left ventricle (LV), we previously proposed pacing sites that are different from those used for a systemic LV. The leads should be placed laterally on opposite sides of both ventricles in patients with short-axis dyssynchrony and a single ventricular physiology with two ventricles, whereas they should be placed at the farthest sites along the longitudinal direction in the right ventricle (RV) in patients with long-axis dyssynchrony of the RV. Moreover, in patients with interventricular dyssynchrony and a biventricular physiology with a systemic RV, they should be placed at sites that both ventricles can contract simultaneously. We retrospectively investigated 27 consecutive procedures in 24 patients with CHD who underwent CRT to evaluate the effectiveness of a new ventricular morphology-based CRT strategy. The responder rate was 63% (17/27). The reasons for a non-response to CRT in 10 cases were as follows: non-optimal lead positions during CRT, 4; no systemic ventricular conduction delay or heart failure symptoms before the CRT, 5; short follow-up periods after the CRT, 2; and an extremely dilated systemic RV, 1. The responder rate became 88% (14/16), after excluding the procedures without a ventricular conduction delay or heart failure symptoms and those with non-optimal lead positions. This new strategy for CRT can provide favorable results for CHD patients with a systemic ventricular conduction delay and heart failure.