Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

• 来源期刊: 老年心脏病学杂志（英文版）
• 年，卷（期）: 2017,（2）
• 页码范围: 118-126
• 页数: 9页
• 语种: 英文
• DOI: 10.11909/j.issn.1671-5411.2017.02.006

摘要

Objective To evaluate left univentricular (LUV) pacing for cardiac resynchronization therapy (CRT) using a rate-adaptive atrioventricular delay (RAAVD) algorithm to track physiological atrioventricular delay (AVD).Methods A total of 72 patients with congestive heart failure (CHF) were randomized to RAAVD LUV pacing versus standard biventricular (BiV) pacing in a 1:1 ratio.Echocardiography was used to optimize AVD for both groups.The effects of sequential BiV pacing and LUV pacing with optimized A-V (right atrio-LV) delay using an RAAVD algorithm were compared.The standard deviation (SD) of the S/R ratio in lead V1 at five heart rate (H-R) segments (Rs/R-SD5),defined as the "tracking index," was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD.Results The QRS complex duration (132 ± 9.8 vs.138 ± 10 ms,P ＜ 0.05),the time required for optimization (21 ± 5 vs.50 ± 8 min,P ＜0.001),the mitral regurgitant area (1.9 ± 1.1 vs.2.5 ± 1.3 cm2,P ＜ 0.05),the interventricular mechanical delay time (60.7±13.3 ms vs.68.3± 14.2 ms,P ＜ 0.05),and the average annual cost (13,200 ± 1000 vs.21,600 ± 2000 RMB,P ＜ 0.001) in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group.The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group (22.7 ± 2.2 vs.21.4 ± 2.1 cm,P ＜ 0.05).The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group,and was significantly negatively correlated with improved left ventricular ejection fiaction (LVEF) (ALVEF,Pearson's r =-0.427,P =0.009),and positively correlated with New York Heart Association class (Spearman's r =0.348,P =0.037).Conclusions RAAVD LUV pacing is as effective as standard BiV pacing,can be more physiological than standard BiV pacing,and can decrease the average annual cost of CRT.