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强化随访结合心电图优化VV间期管理心脏再同步治疗无应答
Management of nonresponder to cardiac resynchronization therapy with disciplinary follow up and electrocardiogram VV interphase optimization
【摘要】 目的:探讨强化随访结合心电图优化VV间期对心脏再同步治疗(CRT)无应答病人的影响。方法:以2006年1月1日至2011年6月30日在我院植入CRT病人为研究对象,至2012年1月1日CRT应答者为A组,无应答者为B组,存活无应答者为C组,强化随访联合心电图VV间期优化半年后为D组。观察指标为死亡、NYHA心功能分级、6 min步行试验及左室射血分数(EF)。结果:共91例病人入选,经过中位34(6~62)个月随访,41例(占45.1%)对CRT无应答,A组与B组相比,缺血型心肌病及QRS宽度≤120 ms差异有统计学意义(均P<0.001)。经过强化随访半年后25例(占27.5%)对CRT无应答。C组与D组相比,NYHA心功能分级、6 min步行试验、EF、QRS宽度≤120 ms差异有统计学意义(均P<0.01)。常规随访后无应答率(占45.1%)与强化随访后无应答率(占27.5%)相比差异有统计学意义(P<0.01)。结论:缺血型心肌病及QRS宽度≤120 ms可能是无应答主要因素;强化随访结合心电图VV间期优化能改善临床症状以及提高EF。
【Abstract】 Objective: To explore the influence of disciplinary follow-up with electrocardiogram optimization VV interphase to nonresponder to cardiac resynchronization therapy.Methods: Patients implanted CRT from January 1,2006 to June 30,2011 were selected as the research object.Till January 1 2012,responder was divided as group A,nonresponder as group B,survived group B as group C,after 6 months disciplinary follow-up as group D.To observe death,New York heart function classification,6 minutes walk distance,EF.Results: A total of 91 patients were included,after the 34(6.0~62.0) months median of follow-up,41 cases(45.1%) were nonresponders,A group compared with B group,ischemic cardiomyopathy and QRS width ≤ 120 ms had statistic significance(P<0.001).After 6 months of disciplinary follow-up,25 cases(27.5%) were nonresponders.New York Heart function classification,six minutes walk distance increased and EF increased(P<0.01).No response rate of regular follow-up and disciplinary follow-up were 45.1% and 27.5% respectively(P<0.01).Conclusion: Ischemic cardiomyopathy and QRS width ≤ 120 ms may be nonresponders main factors.After the disciplinary follow-up combined with ECG VV interphase optimization,the clinical symptoms and the EF improve.
【Key words】 cardiac resynchronization therapy; disciplinary follow up; nonresponder; optimization;
- 【文献出处】 温州医学院学报 ,Journal of Wenzhou Medical College , 编辑部邮箱 ,2013年05期
- 【分类号】R541.6
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