全皮下置入式心律转复除颤器术前QRS-T形态筛查对双心室起搏反应性的预测研究
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摘要
目的:研究全皮下置入式心律转复除颤器(S-ICD)术前心电图QRS-T形态模板匹配筛查(TMS)对于双室起搏患者反应性的预测价值。方法:2016年1月至2017年3月,中国医学科学院阜外医院心脏再同步化治疗CRT(CRT-P/CRTD)置入的患者共55例,利用TMS对患者在心脏再同步化治疗(CRT)置入术前和术后进行S-ICD两种体位三个向量下的心电图描记和筛查,统计TMS通过率。在CRT置入后第6个月对患者进行随访,对比TMS通过与未通过患者的CRT的反应率。结果:所有患者在CRT置入术前,自身心律时均未通过TMS筛查,39例患者(70.9%)在双室起搏状态下通过TMS筛查。TMS通过组中高血压患者的比例低于TMS未通过组(7.7%vs.43.8%,P=0.004)。6个月随访时,TMS通过组有反应和超反应的患者比例明显高于未通过组(有反应:31/36(86.1%)vs.5/16(31.3%),P<0.001;超反应:9/39(23.1%)vs.1/16(6.3%),P=0.026)。三个向量均通过的患者超反应比率高于另外两组(3向量vs.2向量,P=0.018;3向量vs.1向量,P=0.003)。基线时较小的LVEDD、LAD以及双室起搏通过TMS筛查是CRT有反应的预测因素。结论:双室起搏模式下通过TMS的患者CRT置入后更易有反应及超反应。
Objective: We aimed to investigate the electrocardiogram( QRS-T morphology) of the biventricular pacing patients using the subcutaneous implantable cardioverter defibrillator pre-implantable QRST morphology screening( TMS) and the predictive value of TMS for CRT response. Methods: From January2016 to March 2017,55 patients were implanted with Cardiac Resynchronization therapy/defibrillator( CRT-P/CRTD) in Fuwai Hospital,TMS was conducted before and after implantation using an ECG simulating the 3 sensing vectors of the S-ICD. Patients were followed up at the 6 month after CRT implantation to record the response of the CRT. Results: 39 patients( 70. 9%) passed TMS in Biventricular pacing mode while all patients failed to pass the TMS under the intrinsic rhythm. Compared with the non-pass group,the proportion of patients with hypertension in the Biventricular pass group was lower( 7. 7% vs. 43. 8%,P = 0. 004) At the 6 months follow-up,both the two groups improved significantly in the cardiac function. 36 patients were defined as responders to CRT,10 were super responders. More responders and super responders were observed in biventricular pass group than those in the non-pass group( response: 31/36( 86. 1%) vs. 5/16( 31. 3%),P < 0. 001; super response: 9/39( 23. 1%) vs. 1/16( 6. 3%),P = 0. 026) The ratio of super responders in those patients who passed TMS with all three vectors was higher than that of the other two groups( 3 vector vs. 2 vector,P =0. 018; 3 vector vs. 1 vector,P = 0. 003) Smaller baseline LVEDD,LAD,and TMS pass during the biventricular pacing mode were independent predictors of CRT response. Conclusion: The CRT patients who passed the TMS during the biventricular pacing mode are more susceptible to respond to CRT.
Objective: We aimed to investigate the electrocardiogram( QRS-T morphology) of the biventricular pacing patients using the subcutaneous implantable cardioverter defibrillator pre-implantable QRST morphology screening( TMS) and the predictive value of TMS for CRT response. Methods: From January2016 to March 2017,55 patients were implanted with Cardiac Resynchronization therapy/defibrillator( CRT-P/CRTD) in Fuwai Hospital,TMS was conducted before and after implantation using an ECG simulating the 3 sensing vectors of the S-ICD. Patients were followed up at the 6 month after CRT implantation to record the response of the CRT. Results: 39 patients( 70. 9%) passed TMS in Biventricular pacing mode while all patients failed to pass the TMS under the intrinsic rhythm. Compared with the non-pass group,the proportion of patients with hypertension in the Biventricular pass group was lower( 7. 7% vs. 43. 8%,P = 0. 004) At the 6 months follow-up,both the two groups improved significantly in the cardiac function. 36 patients were defined as responders to CRT,10 were super responders. More responders and super responders were observed in biventricular pass group than those in the non-pass group( response: 31/36( 86. 1%) vs. 5/16( 31. 3%),P < 0. 001; super response: 9/39( 23. 1%) vs. 1/16( 6. 3%),P = 0. 026) The ratio of super responders in those patients who passed TMS with all three vectors was higher than that of the other two groups( 3 vector vs. 2 vector,P =0. 018; 3 vector vs. 1 vector,P = 0. 003) Smaller baseline LVEDD,LAD,and TMS pass during the biventricular pacing mode were independent predictors of CRT response. Conclusion: The CRT patients who passed the TMS during the biventricular pacing mode are more susceptible to respond to CRT.
引文
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[20]Ip JE,Wu MS,Kennel PJ,et al.Eligibility of pacemaker patients for subcutaneous implantable cardioverter defibrillators[J].J Cardiovasc Electrophysiol,2017,28(5):544-548.
[21]杨丽,王芸,隗祎,等.永久起搏器置入术后新发心房颤动的影响因素及预后分析[J].心肺血管病杂志,2018,37(2):87-90.
[2]Weiss R,Knight BP,Gold MR,et al.Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator[J].Circulation,2013,128(9):944-953.
[3]Burke MC,Gold MR,Knight BP,et al.Safety and efficacy of the totally subcutaneous implantable defibrillator:2-year results from a pooled analysis of the IDE study and EFFORTLESS registry[J].J Am Coll Cardiol,2015,65(16):1605-1615.
[4]Groh CA,Sharma S,Pelchovitz DJ,et al.Use of an electrocardiographic screening tool to determine candidacy for a subcutaneous implantable cardioverter-defibrillator[J].Heart Rhythm,2014,11(8):1361-1366.
[5]Richardson P,Mc Kenna W,Bristow M,et al.Report of the1995 world health organization/international society and federation of cardiology task force on the definition and classification of cardiomyopathies[J].Circulation,1996,93(5):841-842.
[6]Chalil S,Stegemann B,Muhyaldeen SA,et al.Effect of posterolateral left ventricular scar on mortality and morbidity following cardiac resynchronization therapy[J].Pacing Clin Electrophysiol,2007,30(10):1201-1209.
[7]Castellant P,Fatemi M,Bertault-Valls V,et al.Cardiac resynchronization therapy:“nonresponders“and“hyperresponders”[J].Heart Rhythm,2008,5(2):193-197.
[8]Dai S,Ayres NA,Harrist RB,et al.Validity of echocardiographic measurement in an epidemiological study.Project HeartBeat![J].Hypertension,1999,34(2):236-241.
[9]Blanc JJ,Fatemi M,Bertault V,et al.Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure.A new concept of left ventricular dyssynchrony-induced cardiomyopathy[J].Europace,2005,7(6):604-610.
[10]Killu AM,Grupper A,Friedman PA,et al.Predictors and outcomes of"super-response"to cardiac resynchronization therapy[J].J Card Fail,2014,20(6):379-386.
[11]Antonio N,Teixeira R,Coelho L,et al.Identification of'superresponders'to cardiac resynchronization therapy:the importance of symptom duration and left ventricular geometry[J].Europace,2009,11(3):343-349.
[12]国建萍,王玉堂,单兆亮,等.心电图预测心脏再同步化治疗效果的价值[J].中华心血管病杂志,2016,44(6):483-488.
[13]章超惠,严激,徐健,等.J波、JTc、Tp-ec间期对心脏再同步治疗除颤器患者术后触发治疗的预测价值[J].安徽医科大学学报,2015,(7):1029-1032,1033.
[14]薛聪,华伟,蔡迟,等.心脏再同步治疗对复极离散度和室性心律失常的影响[J].中国循环杂志,2016,31(3):250-253.
[15]Ziacchi M,Corzani A,Diemberger I,et al.Electrocardiographic eligibility for subcutaneous implantable cardioverter defibrillator:evaluation during bicycle exercise[J].Heart Lung Circ,2016,25(5):476-483.
[16]Liakos CI,Grassos CA,Babalis DK.2013 ESH/ESC guidelines for the management of arterial hypertension:what has changed in daily clinical practice?[J].High Blood Press Cardiovasc Prev,2015,22(1):43-53.
[17]Olde Nordkamp LR,Warnaars JL,Kooiman KM,et al.Which patients are not suitable for a subcutaneous ICD:incidence and predictors of failed QRS-T-wave morphology screening[J].J Cardiovasc Electrophysiol,2014,25(5):494-499.
[18]Randles DA,Hawkins NM,Shaw M,et al.How many patients fulfil the surface electrocardiogram criteria for subcutaneous implantable cardioverter-defibrillator implantation?[J].Europace,2014,16(7):1015-1021.
[19]Fontaine JM,Gupta A,Franklin SM,et al.Biventricular paced QRS predictors of left ventricular lead locations in relation to mortality in cardiac resynchronization therapy[J].J Electrocardiol,2015,48(2):226-235.
[20]Ip JE,Wu MS,Kennel PJ,et al.Eligibility of pacemaker patients for subcutaneous implantable cardioverter defibrillators[J].J Cardiovasc Electrophysiol,2017,28(5):544-548.
[21]杨丽,王芸,隗祎,等.永久起搏器置入术后新发心房颤动的影响因素及预后分析[J].心肺血管病杂志,2018,37(2):87-90.