【摘要】：目的觀察三維電激動標測技術(shù)在心臟再同步化治療(CRT)無反應(yīng)擴張型心肌病患者治療中的指導(dǎo)作用。方法選擇CRT無反應(yīng)的擴張型心肌病患者22例,均行三維電激動標測檢查判斷左室電激動最延遲部位;行冠狀靜脈竇逆行造影觀察激動最延遲部位附近血管情況。17例激動最延遲部位附近有血管且無畸形,選擇經(jīng)冠狀靜脈竇途徑植入左室導(dǎo)線;3例激動最延遲部位附近無血管、2例血管畸形,選擇經(jīng)房間隔或室間隔穿刺途徑于激動最延遲部位植入左室心內(nèi)膜導(dǎo)線。分別于手術(shù)前及術(shù)后1、3、6個月對患者心功能及左室同步性進行評價。結(jié)果術(shù)后1、3、6個月,22例患者心功能指標(紐約心臟病協(xié)會心功能分級、6 min步行距離、左室射血分數(shù)、二尖瓣反流程度、左室收縮末期容積)及左室同步性評價指標(室間機械延遲、左室內(nèi)最晚收縮-最早收縮達峰時間、左室12節(jié)段達峰時間標準差)與術(shù)前比較,P均0.05;術(shù)后3個月與術(shù)后1個月比較,P均0.05;術(shù)后6個月與術(shù)后1、3個月比較,P均0.05。結(jié)論三維電激動標測技術(shù)可準確判斷CRT無反應(yīng)擴張型心肌病患者左室電激動最延遲部位,進而選擇最佳途徑植入左室導(dǎo)線,提高患者對CRT的反應(yīng)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.
【作者單位】： 安徽醫(yī)科大學(xué)附屬省立醫(yī)院;
【基金】：安徽省科技攻關(guān)項目(1301042210)
【分類號】：R542.2

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