Study On The Algorithm Of Biventricular Resynchronization Through Left Univentricularpacing Beat-by-beat Tracking Of Physiological Atrioventricular Delay

PurposeThis study intends to apply three chamber pacemaker in patients with chronic congestive heart failure, compared with standard dual chamber pacing, single left ventricular pacing, immediate hemodynamic effect, discusses the single jump left ventricular pacing by tracking physiologic atrioventricular delay the concrete algorithm of the cardiac resynchronization therapy.MethodIn accord with the CRT I class indications and pacemaker implantation three Chambers of patients with chronic congestive heart failure (CHF) of 37 cases,preoperative conventional line 24 hours electrocardiogram inspection, collection room of P ’R’ early stage as the dependent variable, the sinus heart rate before the PR interval period and the sinus heart rate of P wave to room P ’early stage (P - P’interphase) as the independent variable set up by the PR and P - P ’interphase is derived when the room as its physiological AVD regression equation.After three chamber pacemaker implantation, program to single right ventricular pacing, first, to measure the AS - VS interphase (physiologic AVD), then, to single left ventricular pacing again, measure the individualized compensation (ASC), atrial sensing echocardiogram to 10 ms titration AVD, step by step under the titration to aortic blood flow velocity time integral (AVI) and left ventricular ejection fraction (EF), the maximum value for mitral regurgitation in area of the hour AVD in order to optimize the AVD, comparing standard dual chamber pacing, and single left ventricular pacing,immediate hemodynamic effect, calculation of left ventricular top priorities in interphase (that is, the optimization of V - R interphase = the optimization of AS - VS interphase - (the optimization of AVD + ASC) )and left ventricular priority coefficientε ( ε = AVD/ the optimization of AS - VS interphase), set up left univentricularpacing beat-by-beat tracking of physiological AVD realize the algorithm of CRT.ResultBy the PR and P - P ’interphase is derived when the room as its physiological AVD regression equation for: P = 0.022 + 0.954 PR, by evaluating the immediate hemodynamic AVI, MRA, IVMD and duration of QRS wave know LUVP than BVP improvement (P < 0.01 or 0.05), V - R interphase was 19.31 + / - 7.32 ms, left ventricular priority coefficient (ε) was 0.73 + / - 0.04.In conclusion1. The algorithm of left univentricularpacing beat-by-beat tracking of physiological AVD can realize CRT,and it retains the atrioventricular node physiologic atrioventricular delay, eliminates unnecessary right ventricular pacing, more in line with the physiological, extend the service life of the battery at the same time, can reduce the cost of treatment of CRT.2. The algorithm of single left ventricular pacing can optimize the adaptive CRT has applied from "every minute" to "beat-by-beat" for achieving physiological cardiac resynchronization therapy.