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目的探讨右室感知触发左室起搏心脏再同步化治疗(CRT)慢性充血性心力衰竭(CHF)的效果。方法植入三腔起搏器进行心脏超声优化的CHF患者30例,分别测定传统CRT优化后及右室感知触发左室起搏CRT模式的左室射血分数(LVEF)、舒张期二尖瓣血流速度时间积分(MVI)、二尖瓣返流VTI(MR-VTI)、主动脉瓣前向血流VTI(AVI),并与CRT术前及传统CRT右室优先模式(11例)比较上述心脏超声指标、QRS波时限、优化耗时及CRT费用的差别。结果右室感知触发左室起搏模式的平均电池寿命长于传统CRT模式,QRS波时限、优化耗时及CRT年平均费用少于传统CRT模式(均P<0.01);AVI、LVEF、MVI、MR-VTI与传统CRT模式无差异(均P>0.05),但与传统CRT模式高度相关(P<0.01)。右室感知触发左室起搏模式的AVI、LVEF、MVI较右室优先模式增加,MR-VTI较右室优先模式减少(P均<0.05)。结论右室感知触发左室起搏较右室优先的传统CRT模式改善CHF患者的血流动力学,降低CRT年平均费用。
Objective To explore the effect of right ventricular activation triggering left ventricular pacing cardiac resynchronization therapy (CRT) on chronic congestive heart failure (CHF). Methods Thirty patients with CHF undergoing cardiac echocardiography were enrolled in this study. The left ventricular ejection fraction (LVEF), left ventricular ejection fraction (LVEF), left ventricular ejection fraction (MVI), MR-VTI and AVI of aortic valve before and after CRT were compared with CRT preoperative and conventional CRT (n = 11) The above-mentioned indexes of heart ultrasound, QRS wave duration, optimization time-consuming and CRT cost differences. Results The average battery life of right ventricular activation triggered left ventricular pacing mode was longer than that of traditional CRT mode. QRS wave duration, optimized time - consuming and average annual cost of CRT were less than those of traditional CRT (all P <0.01). AVI, LVEF, MVI, MR -VTI had no difference with traditional CRT mode (all P> 0.05), but was highly correlated with traditional CRT mode (P <0.01). AVI, LVEF and MVI in right ventricular activation-triggered left ventricular pacing mode were higher than right ventricular preferential mode and MR-VTI was lower than right ventricular preferential mode (all P <0.05). CONCLUSIONS: Right ventricular activation triggers left ventricular pacing versus right ventricular prior to conventional CRT to improve hemodynamics and reduce the annual average cost of CRT.