【摘要】 目的 分析左心室电极重置术（下称重置术）在心脏再同步化治疗（CRT）无反应心力衰竭（下称心衰）患者中的临床疗效。方法 选择2016年1月至2018年12月在浙江省人民医院心内科住院的首次植入CRT后脉冲发生器电池耗竭且为CRT无反应心衰患者15例，均行重置术。比较左心室电极重置术前后植入部位、QRS时间、左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVESd）、左心室射血分数（LVEF）、纽约心脏病协会（NYHA）心功能分级及6 min步行距离，随访并记录不良事件。结果 左心室导线重置成功14例（93.3%），重置于前侧静脉、侧静脉各5例，后侧静脉3例，心中静脉侧支1例，起搏位点均位于基底/中间起搏段（100.0%）。14例重置成功患者中，CRT有反应8例（57.1%），无反应6例（42.9%）。重置术后QRS时间、LVEDd、LVESd、LVEF、6 min步行试验、NYHA心功能分级均优于重置术前，差异均有统计学意义（均P<0.05）。随访过程中死亡6例，均为心源性死亡，其中4例为重置后无反应者，1例为重置失败者。结论 对于首次CRT无反应者，重置术可改善半数患者CRT疗效。更多还原

【Abstract】 Objective To analyze the clinical effects of left ventricular lead reimplantation on prognosis of heart failure patients with non-response to cardiac resynchronization therapy(CRT). Methods A total of 15 heart failure patients with non-response to CRT underwent left ventricular(LV) lead reimplantation during generator replacement for pacemaker battery depletion from January 2016 to December 2018 in Zhejiang Provincial People’s Hospital. LV lead position, QRS duration, LV end-diastolic diameter(LVEDd) and LV end-systolic diameter(LVESd)diameter, LV ejection fraction(LVEF), NYHA class, 6-min walk distance before and after LV lead reimplantation were compared. All patients were followed up and adverse events were recorded. Results LV lead was reimplanted successfully in 14 patients(93.3%). The reimplantation sites were anterolateral vein in 5 cases, anterior vein in 5 cases,posterolateral vein in 3 cases, and middle cardiac vein in 1 case. Pacing sites were all located at the basal and middle segments(100.0%). The response rate was 57.1% in 14 patients with successful reimplantation. LVEDd, LVESd, LVEF,6-min walk distance and NYHA class were improved after procedure compared to those before procedure(all P<0.05).During follow-up period, 6 patients died due to cardiogenic shock. Of them, 4 cases were non-response after lead reimplantation and one was the patient with lead reimplantation failure. Conclusion LV lead reimplantation may improve clinical efficacy in half of patients with non-response to first CRT.更多还原