First-in-human noninvasive left ventricular ultrasound pacing: A potential screening tool for cardiac resynchronization therapy.
First-in-human noninvasive left ventricular ultrasound pacing: A potential screening tool for cardiac resynchronization therapy.
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DOI：
10.1016/j.hroo.2022.10.008
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发表时间：
2023-03
期刊：
影响因子：
--
通讯作者：
Stadler, Robert W.
中科院分区：
文献类型：
--
作者：
Bilchick, Kenneth C.;Morgounova, Ekaterina;Oomen, Pim;Malhotra, Rohit;Mason, Pamela K.;Mangrum, Mike;Kim, David;Gao, Xu;Darby, Andrew E.;Monfredi, Oliver J.;Aso, Joy A.;Franzen, Peter M.;Stadler, Robert W.
关键词：
一种预测心脏再同步治疗（CRT）反应的筛选工具可以改善患者的选择和治疗效果。
本研究的目的是探讨在CRT植入前将经皮超声左心室（LV）起搏作为一种筛选试验应用于无创CRT的可行性和安全性。
在超声心动图造影剂团注期间给予P波触发的超声刺激，以无创方式模拟CRT。在左心室的多个位置以一系列房室延迟给予超声起搏，以实现与自身心室激动的融合。在基线、超声起搏期间以及CRT植入后，通过美敦力CardioInsight 252电极标测背心获取三维心脏激动图。一个单独的对照组仅接受CRT植入。
10名患者实现了超声起搏，平均每名患者有81.2±50.8个超声起搏的心跳，且超声起搏最多可达连续20个心跳。基线时的QRS波宽度（168.2±17.8毫秒）在最佳超声起搏心跳时显著降低至117.3±21.5毫秒（P <.001），在最佳CRT心跳时降低至125.8±13.3毫秒（P <.001）。CRT起搏和来自左心室同一区域刺激的超声起搏之间的电激动模式相似。超声起搏组和对照组之间的肌钙蛋白结果相似（P = 0.96），证实了其安全性。
CRT前的无创超声起搏是安全可行的，并且它能估计通过CRT可实现的电再同步程度。对这种有前景的技术进行进一步研究以指导CRT患者的选择是有必要的。
A screening tool to predict response to cardiac resynchronization therapy (CRT) could improve patient selection and outcomes. The purpose of this study was to investigate the feasibility and safety of noninvasive CRT via transcutaneous ultrasonic left ventricular (LV) pacing applied as a screening test before CRT implants. P-wave–triggered ultrasound stimuli were delivered during bolus dosing of an echocardiographic contrast agent to simulate CRT noninvasively. Ultrasound pacing was delivered at a variety of LV locations with a range of atrioventricular delays to achieve fusion with intrinsic ventricular activation. Three-dimensional cardiac activation maps were acquired via the Medtronic CardioInsight 252-electrode mapping vest during baseline, ultrasound pacing, and after CRT implantation. A separate control group received only the CRT implants. Ultrasound pacing was achieved in 10 patients with a mean of 81.2 ± 50.8 ultrasound paced beats per patient and up to 20 consecutive beats of ultrasound pacing. QRS width at baseline (168.2 ± 17.8 ms) decreased significantly to 117.3 ± 21.5 ms (P <.001) in the best ultrasound paced beat and to 125.8 ± 13.3 ms (P <.001) in the best CRT beat. Electrical activation patterns were similar between CRT pacing and ultrasound pacing with stimulation from the same area of the LV. Troponin results were similar between the ultrasound pacing and the control groups (P = .96), confirming safety. Noninvasive ultrasound pacing before CRT is safe and feasible, and it estimates the degree of electrical resynchronization achievable with CRT. Further study of this promising technique to guide CRT patient selection is warranted.
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