在心脏再同步化治疗中，作为左室导联定位靶点的右室起搏和内在传导最新电激活位点的一致性

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-05-01 DOI:10.1016/j.hroo.2025.02.006

Henrik Laurits Bjerre MD , Jens Cosedis Nielsen MD, PhD, DMSc , Anders Lehmann Dahl Pedersen MD , Christian Gerdes MD, PhD , Jens Kristensen MD, PhD , Jesper Møller Jensen MD, PhD, DMSc , Bjarne Linde Nørgaard MD PhD, DMSc , Mads Brix Kronborg MD, PhD, DMSc

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引用次数: 0

摘要

在心脏再同步化治疗（CRT）中，研究表明，针对左心室（LV）导联的最新电激活部位可以改善临床结果。这个部位是否应该在右心室起搏或内在传导时确定尚不清楚。目的探讨左心室起搏与内在传导在确定CRT患者最新电激活部位方面的一致性。方法在CRT植入过程中，我们两两测量了从QRS开始到本征传导（Q-LV）时局部左室激活的时间间隔，以及从左室导联上的起搏信号到左室起搏（rvp -LV）时局部左室激活的时间间隔。在DANISH-CRT（电靶向左室导联定位是否改善心力衰竭和QRS延长患者的预后）试验中，随机分配到干预组的符合条件的患者的静脉根尖位置。通过计算机断层扫描验证静脉解剖和最终导联位置。结果共纳入61例患者，测量了209条静脉531节段的间隔。我们发现rvp - lv和Q-LV在识别最新激活静脉方面有很大的一致性（Cohen加权kappa系数0.69[95%置信区间0.62-0.76]）。右心室导联主要指向室间隔前区，rvp - lv比Q-LV更倾向于后静脉。我们发现rvp - lv和Q-LV测量值在观察者内部和观察者之间具有很高的信度。结论左室起搏时的rvp -LV与内导时的Q-LV在确定CRT中左室导联位置的最佳靶点上有很大的一致性。尽管如此，三分之一的患者的最佳靶静脉发生了变化，因为rvp - lv比Q-LV更倾向于后靶静脉。

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Agreement on site of latest electrical activation between right ventricular pacing and intrinsic conduction as target for left ventricular lead position in cardiac resynchronization therapy

Background

In cardiac resynchronization therapy (CRT), studies indicate that targeting the left ventricular (LV) lead toward the site of latest electrical activation could improve clinical outcomes. Whether this site should be determined during right ventricular (RV) pacing or intrinsic conduction is unknown.

Objective

The study sought to investigate agreement between RV pacing and intrinsic conduction in identifying the site of latest electrical activation in patients undergoing CRT.

Methods

During CRT implantation, we obtained pairwise measurements of the interval from QRS onset to local LV activation during intrinsic conduction (Q-LV) and the interval from the paced signal on the RV lead electrogram to the sensed local LV activation during RV pacing (RV_p-LV_s) in the basal, mid, and apical positions of eligible veins in patients randomized to the intervention arm in the DANISH-CRT (Does Electric Targeted LV Lead Positioning Improve Outcome in Patients With Heart Failure and Prolonged QRS) trial. Venous anatomy and final lead positions were verified by computed tomography.

Results

We included 61 patients and measured intervals in 209 veins with 531segments. We found substantial agreement between RV_p-LV_s and Q-LV in identifying the latest activated vein (Cohen’s weighted kappa coefficient 0.69 [95% confidence interval 0.62–0.76]). The RV lead was predominantly positioned toward the anteroseptal region and RV_p-LV_s favored a posterior vein more often than Q-LV. We found high intra- and interobserver reliability for RV_p-LV_s and Q-LV measurements.

Conclusion

There is substantial agreement between RV_p-LV_s during RV pacing and Q-LV during intrinsic conduction in identifying the optimal target for LV lead position in CRT. Still, the optimal target vein changed for one-third of patients as RV_p-LV_s favored a posterior target vein more often than Q-LV.

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来源期刊

Heart Rhythm O2 Cardiology and Cardiovascular Medicine

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

52 days