Application Efects Of Adaptive Left Ventricular Pacing On CRT In Patients With Chronic Heart Failure

Objective : In recent years,as people of Cardiac resynchronization therapy(Cardiac resynchronization therapy,CRT)cognitive increasingly deepening and recognition of physiologic pacing,adaptive left ventricular pacing in chronic congestive heart failure(CHF)in CRT treatment gradually occupy their position.Application of adaptive left ventricular pacing,the way of physiologic pacing for CRT treatment in patients with chronic congestive heart failure,the main approaches including the United States developed by medtronic Adaptiv CRT ? frequency adaptive algorithm of adaptive CRT and atrioventricular delay function(RAAV)reach the purpose of single left ventricular pacing,cardiac resynchronization therapy.The purpose of this retrospective study was to observe the application effect of the two adaptive left ventricular pacing methods in chronic heart failure cardiac resynchronization therapy(CRT).Methods : Selection in our hospital from January 2014 to December 2014,Qingdao university hospital cardiovascular internal medicine,in line with the ESC heart failure in2016 CRT and ICD in the guide I class A cardiac resynchronization therapy indication and successfully implanted CRT-P/D of 30 cases of patients with chronic congestive heart failure.According to the different groups are implanted pacemaker model,study A group of10 cases of Adaptiv CRT ? treatment group,20 cases as study group B frequency adaptive atrioventricular delay in treatment group(with A key program optimization of AV/VV interphase features of CRT-P/D).The operation mode of group A was programmed as adaptive Biv and LV.Group B perfect 24-hour dynamic electrocardiogram in patients with preoperative,or the amount of activity at least 10 minutes before the SPC,within the cavity of the measure and control instrument in the diagram under different heart rate measurement of interphase,determination of atrial aware of-ventricular(AS-v)period,the PR under the inner room rate for 24 hours,the corresponding relationship between its own PR interphase individualized based on function relation of the two(y = ax+b),computing a&b constant AS the basis for the determination of pacemaker RAAV parameters.Postoperative use of pacemaker ecg(IEGM)program in the key period between optimizing atrioventricular delay and VV,and obtain the corresponding parameters,and then under the guidance of mentors and pacemaker manufacturers and technical personnel to the CRT SPC for left ventricular pacing alone,keep in perception and ICD function,set up corresponding parameters and start the RAAV function,into the follow-up.The relevant indicators of the two groups were obtained,including the QRS time limit,VTI,SPWMD,TQ-AV-TQ-PV,LVEF,MRA,LVEDD,BNP,6-mwt,and the control group.Results:The QRS wave duration,VTI,SPWMD,TQ-AV-TQ-PV,LVEF,MRA,LVEDD,BNP and 6-MWT in the 3,6,9 and 12 months after implantation were significantly improved in the 2 groups(P<0.05).Conclusions:1.Adaptive CRT can adjust the Adaptive LV pacing and Bi V pacing according to the clinical needs of patients,and dynamically optimize the period of SAV/PAV.The VV interval was dynamically optimized according to the self-conduction and QRS wave group width on the right side of the patient.Reduce unnecessary right ventricular pacing;It can significantly improve the cardiac function,reverse ventricular remodeling,shorten the QRS time limit,and increase the walking distance by 6min.2.Frequency adaptive atrioventricular delayed single left ventricular pacing algorithm can realize physiologic pacing in cardiac resynchronization therapy,simplify CRT optimization procedure,improve cardiac function,reverse ventricular remodeling,shorten QRS wave duration,and increase 6min walking distance.The effect is obvious.3.The AV/VV interval can be optimized by the program automatic monitoring method of intracavity electrocardiogram(IEGM),which is simple and fast,and has good correlation with the optimization under the guidance of ultrasound.