| ObjectClear single left ventricular pacing with rate adaptive AV (RAAV) algorithm can track the physiological atrioventricular delay right to realize cardiac resynchronization therapy (CRT), its acute hemodynamic effect is not inferior standard biventricular pacing (BVP).MethodSelection of 05,2013 to 03,2015 were admitted first affiliated hospital of Kunming Medical University, in line with the ACC/AHA guidelines CRT I class A indication and successfully implanted CRT-P/D,64 cases of patients with chronic congestive heart failure (male 50 cases,female 14 cases;mean age:54.37+/-13.85 years), with 54 cases of DCM,10 cases of ICM. The rate adaptive AV single left ventricular pacing group (study group) 32 cases;Another 32 cases according to the baseline data of 1:1 matching standard biventricular pacing patients as control group. The study group before the operation and the normal control group complete 24h"s dynamic electrocardiogram, based on changes in heart rate as the independent variable (x), PR interval period change as the dependent variable (y) is derived by the heart rate change PR interval period change function as the basis of rate adaptive AV. Postoperative cardiac ultrasound optimization, according to the above function Settings RAAV parameters, set to single left ventricular pacing, keep in perception and ICD function, start the RAAV function, into the follow-up. Follow-up content including:different dynamic electrocardiogram measurement of heart rate in QRS wave width, observation of QRS wave form. Standard biventricular pacing group of postoperative to optimize AV and VV interphase by cardiac ultrasound, then enter the follow-up. The other 32 cases in medical health as normal control group. Compare differences function of PR interval period changes in heart rate between study group and normal control group (now the rate adaptive AV algorithm of each manufacturer are based on the normal). Comparison between the study group and control group have acute hemodynamic effect and heart function improvement without difference. Using SPSS 15.0 statistical package analysis data,there are significant differences for the P< 0.05.Result1.64 cases of patients,32 cases with the DDD mode(left ventricular+right atrial pacing mode),32 cases with the CRT-P/D mode(left ventricular+right ventricle+ right atrial pacing mode)were successfully implanted pacemaker, standard biventricular pacing and rate adaptive AV single left ventricular pacing mode of each index comparison results are as follows:The optimal AVD (standard biventricular pacing:113.4+/-8.3ms and rate adaptive single left ventricular pacing:130.3+/-9.7ms,P<0.001); Delay between ventricular (standard biventricular pacing:25.9+/-8.6ms and rate adaptive single left ventricular pacing:21.3+/-7.9ms, P=0.03). QRS width (standard biventricular pacing:142+11ms and rate adaptive single left ventricular pacing:136+10ms,P=0.03).Area of mitral valve regurgitation (standard biventricular pacing:3.7+/-1.2cm squared and rate adaptive single left ventricular pacing:3.1+/-1.1cm squared,P=0.04). Aortic velocity time integra (standard biventricular pacing:20.6+/-2.1cm and rate adaptive single left ventricular pacing:21.8+/-2.3cm,P=0.03). Optimization of time consuming (standard biventricular pacing:52+/-8 min and rate adaptive single left ventricular pacing:20+/-4 min,P<0.001); Battery life (standard biventricular pacing:4.5+/-0.2years and rate adaptive single left ventricular pacing:7.8+/-0.3years,P<0.001); The average annual cost of treatment (standard biventricular pacing:2.2+/-0.210 thousand/year and rate adaptive single left ventricular pacing:1.3+/-0.110 thousand/year, P<0.001); Interventricular mechanical delay time (standard biventricular pacing:72.3+/-13.6ms and rate adaptive single left ventricular pacing:64.2+/-12.8ms,P=0.02).The above indicators has statistical significance.Left ventricular ejection fraction (standard biventricular pacing:0.34+/-0.03 and rate adaptive single left ventricular pacing:0.35+/-0.04,P= 0.26). EA peak time (standard biventricular pacing:220+52ms and rate adaptive single left ventricular pacing:208+56ms,P=0.38). The diameter of left atrium (standard biventricular pacing:40.4+/-10.5mm and rate adaptive single left ventricular pacing:38.3+/-9.6 mm,P=0.41).Left ventricular end-diastolic diameter (standard biventricular pacing:70.3+/-10.5mm and rate adaptive single left ventricular pacing:67.2+/-10.9mm,P=0.25).6 min walking experiment (standard biventricular pacing:490+/-46m and rate adaptive single left ventricular pacing:515+/-58m,P=0.06). The 12 segmental of the left ventricular tmax standard deviation (standard biventricular pacing:98+/-26ms and rate adaptive single left ventricular pacing:87+/-21ms,P=0.07).The above indicators has no statistical significance.2. The relationship between heart rate and PR interphase of the study group and the normal control groupThe linear regression equation of the relationship between heart rate and PR interphase of the study group:y=-1.1741x+265.57. The linear regression equation of the the variation relationship between heart rate and PR interphase of the study group:y= 0.7658x+10.139. The linear regression equation of the relationship between heart rate and PR interphase of the normal control group:y=-1.0220x+240.37. The linear regression equation of the variation relationship between heart rate and PR interphase of the normal control group:y= 1.0117x-0.2583.3. The pacemaker manufacturers RAAV algorithm1) The rate adaptive AV interphase algorithm of Biotronik company:PR interval period as the change of heart rate capacity is divided into high, medium and low three levels, each level in the start rate and end rate in different heart rate make the PR interval period between a step change.2) The rate adaptive AV interphase algorithm of Medtronic company:AV delay between the the start rate and end rate with the change of heart rate is linear change.3) The rate adaptive AV interphase algorithm of S.t jude company:sinus rate below 90 BPM, AV interphase maintain parameters setting; After sinus rate of more than 90 BPM, AV interphase will shorten linear; PR interval period variation is divided into high, medium and low three levels (heart rate increase 1 times, each level of the AV interphase shortened 3 ms,2 ms,l ms). The shortest period between variable AV value is limited by the shortest AV interphase set.4) The rate adaptive AV interphase algorithm of Boston scientific company:between the start rate and end rate, AV interphase with the change of heart rate increase or decrease is linear change, perception compensation also follow heart rate change with a linear change.Conclusionl.The RAAV single left ventricular pacing algorithm can track the physiological atrioventricular delay right to realize cardiac resynchronization therapy.2.The acute hemodynamic effect of RAAV single left ventricular pacing is not inferior standard biventricular pacing (BVP).3. The RAAV single left ventricular pacing can simplify the CRT optimization program, extend battery life, reduce the 50% average annual cost of treatment of the CRT.4. The RAAV algorithm of Medtronic and Boston scientific company can better realize the CRT through RAAV single left ventricular pacing. |
PDF Full Text Request