The Application Of Quadripolar LV Lead In Cardiac Resynchronization Therapy By Evaluating Heart Synchronicity And Acute Hemodynamic Changes With Echocardiography

Objective: To explore the effect of quadripolar LV lead on cardiac resynchronization therapy(CRT) by evaluating heart synchronicity and acute hemodynamic changes using new technical indexes of echocardiography. Methods : Patients in CRT indications given CRT-D surgery successfully were selected from Jun. 2014 to Oct. 2013 and divided into quadrupole LV lead group and bipolar LV lead group according to the type of left ventricular lead. Echocardiographic Examinations were performed before surgrey and one week after surgrey when in optimal pacing parameter,from which getting the Cardiac synchronization indexes,including septal to posterior wall motion delay(SPWMD) by M-type ultrasonic cardiogram,standard deviation of 12 LV segments’ Ts(Ts-SD) by tissue doppler imaging(TDI),the standard deviation of the peak time of systolie radial strain(Trs-SD) and the standard deviation of the peak time of systolie radial strain rate(Trsr-SD) of 18 LV segments by two-dimensional speckle tricking(2D-STI),the deviation of time to minimum systolic volume of the 16 LV segments(Tmsv16-SD) and the time to minimum systolic volume of the 16-segmental standard deviation as a ratio of R-R interval(Tmsv16-SD % /R-R) by real-time 3-dimensional echocardiography(RT3DE), and the acute hemodynamic indexes, including stroke volume(SV), cardiac output(CO) and mitral regurgitati(MR).Explore the effect of these two type of LV lead on on CRT by comparing the difference of heart synchronicity and acute hemodynamic before surgrey and one week after surgrey between quadrupole LV lead group and bipolar LV lead group.Results: 60 patients were selected into this study and both quadrupole LV gruop and bipolar LV gruop had 30 patients.There were no significant difference in age,gender,QRS duration,medications,indexes of heart synchronicityand hemodynamics before surgery between the two groups.Heart synchronicity are improved one week after surgery of all patients(P<.0.01). Evaluation of heart synchronicity between the two groups,there were no significant difference SPWMD,but Ts-SD(vs,P<.0.05),Trs-SD(vs,P<.0.05), Trsr-SD(vs,P<.0.05),Tmsv16-SD(vs,P<.0.01),Tmsv16-SD(%R-R)(vs,P<0.01) in quadrupole LV lead group were superior to these in bipolar LV lead group one week after surgery.At the same time,acute hemodynamic changes of all patients is improved after surgery(P<.0.05),quadrupole LV lead group had a significantly higher level of SV and CO than bipolar LV leadgroup(P<.0.01),but the MR did not significantly reduced compared with bipolar LV lead gruop(P>.0.05).Conclusion: Compared with bipolar LV lead,quadripolar LV Lead could make better contributions to hearts synchronicity and acute hemodynamic.