| PurposeThis study was designed to explore the feasibility and effectiveness of cardiac resynchronization achieved by CRT-setting of individual rate adaptive AV delay and systolic left ventricular pacing alone in the patients with anti-heart failure pacing system implantationMethod30patients were selected who were admitted to the First Affiliated Hospital of Kunming Medical University with chronic congestive heart failure between January2008to March2013, and CRT-P/D were successfully implanted in line with ACC\AHA guide for CRT class I indications. The patients of22males and8females were mean age of57.42±10.34years old including27cases of dilated cardiomyopathy and3cases of ischemic cardiomyopathy. The two modes of treatment of traditional CRT biventricular pacing and separate left ventricular pacing were given to the same patients during following up to observe the number of cardiac ultrasound detection indicators. In100%of the traditional CRT dual-chamber pacing with reference to the ACC\AHA guidelines, we set shorter pacing system atrioventricular delay (AVD) to ensure that the left/right ventricular electrode completely took away the ventricular Under this premise by means of ultrasound optimization AVd VVD; In separate left ventricular pacing mode, we turn off CRT right ventricular pacing, and two-way titration program-controlled optimization of CRT AV delay set individual rate adaptive AV delay to ensure that the left ventricular electrode100%won by the premise of the left ventricle, it aims that the ventricular excitation is induced by both atrioventricular node passed excitement and stimulation of left ventricular electrodes. It also aims that according to the detected heart rate and PR interval in negative correlation function to set the CRT rate adaptive AV delay, CRT AV interphase also change with changes in heart rate itself. The blood flow velocity time integral of the aortic valve, mitral regurgitation area, left ventricular ejection fraction, and left ventricular end-diastolic diameter were measured and collected in ultrasound to evaluated cardiac function between the two groups. The efficacy and feasibility of left ventricular pacing alone were evaluated by comparing with the traditional CRT pacing mode using SPSS17.0statistical package with significant difference of P <0.05sentenced.Result1. In the30cases of patients,2CRT-P and28CRT-D were successfully implanted without major surgery complications and both traditional CRT100%biventricular pacing and left ventricular pacing alone can be achieved, The pacing mode time required for program-controlled optimization of left ventricular pacing alone mode is shorter than the time required to optimize the traditional CRT pacing mode (33.90±1.73min and89.63±4.64min, P<0.0001), and expected lifetime of CRT last longer (4.76±0.13years and6.02±0.17years, P<0.0001),and minimum of5years up to6.8years,with lower expected average annual cost of treatment (2.54±0.07million and2.00±0.05million, P<0.0001).2. The best SAVd in separated left ventricular pacing mode is120to210ms with average of164ms which is longer than the traditional CRT model of90to190ms and an average139ms (P<0.003). The SAVd in two pacing modes show a positive correlation (r=0.527, P<0.003).3. In the separated left ventricular pacing mode, the QRS duration of the14patients (46.7%) is shorter than the traditional CRT model (148.8±15.24ms128.8±22.10ms, P=0.037),5patients (16.7%) had QRS duration that is widened than traditional CRT mode (150.67±32.04ms and165.33±33.72ms, P=0.016). No change shown in the QRS duration between the two modes in11patients (36.6%)(151.67±10.04ms).4. In immediate comparison after the program-control, There is no significant statistical difference in the EA peak time of two CRT modes (131.67±29.23and142.90±32.49, P>0.05), left ventricular ejection time before (213.17±18.73and218.03±18.56, P>0.05), ventricular mechanical delay time (45.77±8.63and39.73±7.84, P>0.05). The right ventricular pre-ejection time in Left ventricular pacing alone mode is longer than those in traditional CRT model (167.40±16.17and176.30±17.71,P<0.05).5. In left ventricular pacing alone mode the left ventricular ejection fraction is better (34.93±2.84and36.97±3.36, P<0.05) and prior to aortic blood flow velocity time integral is also better (18.03±1.22and18.98±1.04, P<0.05). There was no significant difference in left ventricular end-systolic diameter (64.50±3.25and64.73±3.37, P>0.05), left ventricular end-diastolic diameter (71.47±2.93and71.57±3.16, P>0.05), E peak (95.07±8.73and97.07±7.92, P>0.05), A peak (90.60±6.42and91.73±8.39, P>0.05), mitral regurgitation area (4.74±1.00and4.88±1.88, P>0.05) between the two modes of CRT groupsConclusion1) The traditional CRT pacing abandoned atrioventricular pacing and right ventricular apex, A new cardiac activity dyssynchrony can be leaded to during the same time of striving to systolic resynchronization, which may be one of the reasons why there is no response in some patients for CRT2) CRT set in individual rate adaptive AV delay of the individual left ventricular pacing alone can correct dyssynchrony in cardiac electrophysiology in consistent with the principle of physiological pacing, which can both increase cardiac output and improve the prognosis of patients with heart failure.3) Under ensuring of100%of the left ventricular pacing, the atrioventricular node and right ventricular activation sequence inherent are reserved, This option is simple, non-invasive and safe, without increasing the types of medication/dose to reduce the time and difficulty of follow-up, with great application prospects. |
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