Application and Research of Left Bundle Branch-Optimized Cardiac Resynchronization Therapy in Ischemic Cardiomyopathy.

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Reviews in cardiovascular medicine Pub Date : 2025-03-21 eCollection Date: 2025-03-01 DOI:10.31083/RCM26240
Denghong Zhang, Mingjian Lang, Benjamin Samraj Prakash Earnest, Ihab Elsayed Mohamed Ali Abdou
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Abstract

Background: This study aimed to evaluate the effectiveness of left bundle branch-optimized cardiac resynchronization therapy (LOT-CRT) in patients diagnosed with heart failure and reduced ejection fraction due to ischemic cardiomyopathy.

Methods: A total of 78 patients with ischemic cardiomyopathy who underwent pacemaker implantation at a single center between March 2020 and March 2022 were randomly assigned to two groups based on different pacing methods: LOT-CRT group (n = 39) and biventricular pacing (BVP) group (n = 35). Pacing threshold, impedance, electrocardiogram QRS wave duration during pacing, ventricular pacing ratio during follow-up, and cardiac ultrasound-related indicators were compared immediately after surgery and at the six-month follow-up.

Results: The two groups were similar regarding baseline characteristics, cardiac ultrasound and magnetic resonance imaging (MRI) parameters, and overall cardiac function. However, the BVP group demonstrated higher pacing thresholds and impedance levels immediately after surgery and at the six-month follow-up (p < 0.001). Moreover, the X-ray exposure time was significantly longer in the BVP group compared to the LOT-CRT group. While no significant differences in QRS duration were observed between the groups preoperatively, the QRS duration in the LOT-CRT group was significantly shorter both immediately after surgery and during follow-up (p < 0.001). No significant differences were found between the groups in terms of the New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), or left ventricular end-diastolic diameter (LVEDD). Six months post-surgery, both groups showed modest improvements in NYHA class, LVEF, and LVEDD, with the LOT-CRT group demonstrating significant improvements (p < 0.001).

Conclusions: LOT-CRT may be an alternative treatment for patients with heart failure complicated by left bundle branch block due to ischemic cardiomyopathy in whom BVP is ineffective.

研究背景本研究旨在评估左束支优化心脏再同步化治疗(LOT-CRT)对因缺血性心肌病导致射血分数降低并被诊断为心力衰竭患者的有效性:2020年3月至2022年3月期间,在一个中心接受起搏器植入术的78名缺血性心肌病患者根据不同的起搏方法被随机分配到两组:LOT-CRT组(39人)和双心室起搏(BVP)组(35人)。比较两组患者的起搏阈值、阻抗、起搏时的心电图 QRS 波持续时间、随访时的心室起搏比以及术后即刻和随访 6 个月时的心脏超声相关指标:两组患者的基线特征、心脏超声和磁共振成像(MRI)参数以及整体心脏功能相似。然而,BVP 组在术后即刻和六个月随访时显示出更高的起搏阈值和阻抗水平(P < 0.001)。此外,与 LOT-CRT 组相比,BVP 组的 X 光曝光时间明显更长。虽然术前两组的 QRS 持续时间无明显差异,但术后即刻和随访期间,LOT-CRT 组的 QRS 持续时间明显更短(p < 0.001)。两组在纽约心脏协会(NYHA)功能分级、左心室射血分数(LVEF)或左心室舒张末期直径(LVEDD)方面无明显差异。手术后六个月,两组患者的NYHA分级、LVEF和LVEDD均有适度改善,其中LOT-CRT组有显著改善(p < 0.001):LOT-CRT可能是缺血性心肌病导致左束支传导阻滞并发心力衰竭且BVP无效患者的一种替代治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reviews in cardiovascular medicine
Reviews in cardiovascular medicine 医学-心血管系统
CiteScore
2.70
自引率
3.70%
发文量
377
审稿时长
1 months
期刊介绍: RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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