Clinical Study Of Three Dimensional Electrical Mapping Technique In The Treatment Of CRT Non Response

Objective:In order to solve the clinical problem of cardiac resynchronize therapy(CRT)non-response in patients with chronic heart failure,the advanced technology--three-dimensional electrical activation mapping is used to evaluate cardiac electricity dyssynchrony and left ventricle lead is implanted via different pathways based on patients' individual difference and practical conditions;after self-control before and after,to clarify its influence and mechanism on CRT curative effect and provide a new idea for improving CRT curative effect.Methods: 22 CRT non-response patients that accord with inclusion standards:(1)6 months after CRT implantation,the patients still suffered from heart failure,left ventricular end systolic volume(LVESV)shrinking < 15% and left ventricular ejection fraction(LVEF)increasing< 5%;(2)cardiac electricity dyssynchrony;(3)the distance between the original pacemaker lead and the electricity activation ?5cm;(4)the patients were followed up for clinical condition and ultrasonic cardiogram at least 6 months.Exclusion criteria: A.CRT patients with significant decrease of bi-ventricular pacing rate caused by auricular fibrillation,frequent premature beat;B.unstable angina or acute myocardial infarction in 3 months;C.coronary artery bypass grafting in 3 months;D.stroke in 3 months;E.patients with abnormal renal function;F.patients with late malignant tumor;G.patients who are reluctant to participate in this study,or have to attend other research;H.patients that cannot be communicated with effectively[1,2].All patients underwent three-dimensional electrical activation mapping to find the most delayed part of left ventricular electrical activation.During the operation,coronary sinus retrograde radiography was carried out to know the branch vessel condition of coronary sinus and to observe whether there is proper vessel near the most delayed part of the activation.If there was proper vessel,left ventricular lead was implanted via coronary sinus in the left ventricular electrode setting position near to the most delayed part of electric activation;if there was no proper vessel or there was vascular malformation,then left ventricular endocardium lead was implanted in the most delayed part of activation by choosing interatrial septum puncture pathway or interventricular septum puncture pathway.Results: 22 patients were followed up in 1,3,6 month after CRT left ventricle lead implantation.In 1,3,6 month after operation,patients' left ventricular end systolic volume(LVESV)was smaller compared with that before operation(P<0.05),left ventricular ejection fraction(LVEF)was increased(P<0.05),the degree of mitral regurgitation(MR degree)was lower compared with that before operation(P<0.05)and 6min walking distance(6min)was longer compared with that before operation(P<0.05).In 6 months after the operation,LVESV is improved obviously;the improvement of LVEF after 1 months of the most obvious improvement,3,6 months tended to be stable;the duration of QRS after operation compared with preoperation significantly reduced,with statistical significance(P<0.05);the degree of MR after 6 months may improve significantly;the 6 minute walking distance in 1,3,6 months after operation to improve the amplitude stabilized.Conclusion: In patients with chronic heart failure CRT non-response,three-dimensional electrical activation mapping can be used to evaluate left ventricular electricity dyssynchrony and then accurately choose the best pathway to implant left ventricle lead to be near to the most delayed part of electrical activation,thus improving patients' reactivity.