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心脏再同步治疗(CRT)作为一种新治疗心力衰竭的方法,疗效确切,但是心脏再同步-心力衰竭研究(CARE-HF)证实仍然有20%～30%患者对CRT治疗无反应。目前认为提高CRT疗效除了严格适应证选择、左室电极的正确放置外,术后进行房室间期(AV间期)以及心室同步(VV间期)优化是一项重要措施。迄今为止,已经提出很多指导优化程控的方法,如心电图、超声心动图、核素心室显像、磁共振描记成像等。就心电图而言,心电图简单而且在理论上有助于CRT的优化程控,但是忽略了心肌各部位之间的电机械延迟;同心电图相比,超声心动图指标有重要的实践意义,是CRT术后优化程控的有效方法。但是CRT术后优化程控仍然面临重大挑战,最佳AV存在个体差异,而且随着心率的变化而改变,因此个体化的动态优化程控是今后发展的方向。
Cardiac resynchronization therapy (CRT) is a new treatment for heart failure and its efficacy is very good, but the Cardiac Resynchronization-Heart Failure Study (CARE-HF) confirms that 20% to 30% of patients still have no response to CRT. Currently considered to improve CRT efficacy in addition to strict indications choice, the correct placement of left ventricular electrodes, postoperative AV interval and ventricular synchronization (VV interval) is an important measure of optimization. So far, many methods for guiding the optimization of programmed procedures have been proposed, such as electrocardiography, echocardiography, radionuclide imaging, and magnetic resonance imaging. In the case of electrocardiogram, electrocardiography is simple and theoretically helpful for the optimization of CRT control, but ignores the mechanical delay between the various parts of the myocardium; echocardiography compared with ECG, there is an important practical significance of CRT surgery After optimizing the program-controlled method. However, after the CRT optimization program control is still facing major challenges, the best AV exist individual differences, but also changes with the change of heart rate, so individualized dynamic optimization program control is the future direction of development.