心率适应性心房支持与VDD起搏对心脏再同步化治疗患者的影响：一项随机交叉研究。

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2024-12-17 DOI:10.1016/j.ahj.2024.12.005

Luca Donazzan MD , Francesca Bulian MD , Massimiliano Maines MD , Martin Erckert MD , Francesco Peruzza MD , Werner Günther Rauhe MD , Daniele Giacopelli PhD , Massimiliano Manfrin MD

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引用次数: 0

摘要

背景：心脏再同步化治疗（CRT）是心力衰竭的基础治疗方法，但最佳起搏模式仍不确定。本研究探讨了DDDR（速率适应性心房支持）与VDD起搏模式对使用crt除颤器患者功能容量和超声心动图结果的影响。方法：在一项多中心、双盲、交叉试验中，26例接受crt除颤器植入的窦性心律失常患者被随机分配到每分钟60次的DDDR或每分钟30次的VDD。每种起搏模式维持6个月（第1期），然后再切换到备用程序6个月（第2期）。在基线和每个周期后评估6分钟步行测试（6MWT）所覆盖的距离和超声心动图参数。结果：6个月时CRT应答率为73%，12个月时为79%。DDDR起搏产生的心房起搏中位数百分比为55%（四分位数范围为48%-71%）。DDDR和VDD模式在6MWT距离上无显著差异（448 m [369-538] vs. 428 m [360-535], p=0.71）。起搏模式的顺序也不显著（p=0.17），而研究时间（p=0.03）和基线覆盖的距离(p)结论：在该队列中，心率适应性心房支持在功能容量或超声心动图反应方面没有比VDD起搏有任何优势。这些发现支持了在CRT设备中最大限度地检测固有窦性心律的建议。试验注册：ClinicalTrials.gov标识符：NCT06592690。

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Effect of rate-adaptive atrial support compared to VDD pacing in cardiac resynchronization therapy recipients: A randomized cross-over study

Background

Cardiac resynchronization therapy (CRT) is a cornerstone treatment for heart failure, yet the optimal pacing mode remains uncertain. This study investigates the impact of DDDR (rate-adaptive atrial support) versus VDD pacing modes on functional capacity and echocardiographic outcomes in patients with CRT-defibrillators.

Methods

In a multicenter, double-blind, crossover trial, 26 sinus rhythm patients undergoing CRT-defibrillator implantation were randomized to DDDR at 60 beats-per-minute or VDD at 30 beats-per-minute. Each pacing mode was maintained for 6 months (period 1), followed by crossover to the alternate programming for additional 6 months (period 2). Distance covered in the 6-minute walk test (6MWT) and echocardiographic parameters were evaluated at baseline and after each period.

Results

The proportion of CRT responders was 73% at 6 months and 79% at 12 months. DDDR pacing yielded a median atrial pacing percentage of 55% (interquartile range, 48%-71%). No significant difference was found between DDDR and VDD modes in 6MWT distance (448 m [369-538] vs. 428 m [360-535], P = .71). The sequence of pacing modes was also not significant (P = .17), while the study period (P = .03) and the distance covered at baseline (P < .01) were positively correlated with the distance walked at follow-up. Echocardiographic parameters, including left ventricular ejection fraction and ventricular volumes, showed no significant differences between the pacing modes.

Conclusions

In this cohort, rate-adaptive atrial support did not offer any advantage over VDD pacing in terms of functional capacity or echocardiographic response. The findings support the recommendation to maximize intrinsic sinus rhythm sensing in CRT devices.

Trial registration

ClinicalTrials.gov Identifier: NCT06592690.

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.