Clinical Application Of Cardiac Resynchronization Therapy With Multipoint Pacing In Patients With Chronic Heart Failure With Relatively Wide QRS Complex

Background: Cardiac resynchronization therapy(CRT)can benefit patients with chronic heart failure(CHF)with wide QRS complex.CRT not only can improve clinical symptoms and enhance cardiac function,but also can reduce heart failure rehospitalization rate and mortality.However,through echocardiography,it was found that some patients with CHF with narrow QRS complex also have mechanical desynchronization.Clinical studies have shown that CRT can benefit patients with CHF with narrow QRS complex.However,at present,there is no unified conclusion whether CRT can be implanted in patients with CHF with 120ms<QRS<130ms and desynchronization.Objective: Observe the safety and effectiveness of cardiac resynchronization therapy with multiple sites left ventricular pacing(CRT-MPP)in the treatment of patients with CHF with relatively wide QRS complex and desynchronization.Methods: A retrospective analysis of the clinical material of 30 patients with CHF with 120ms<QRS<130ms and desynchronization who were treated in the Department of Cardiology,The 940 th Hospital of Joint Logistics Support Force of Chinese PLA from June 2016 to September 2019.It is divided into two groups according to treatment methods:medication group(optimal heart failure medical therapy,OMT group)and operation group(optimal heart failure medical therapy combined with CRT implantment,OMT+CRT group).Use inter-group control,self comparison before and after,compare all enrolled patients at baseline,followed up to the 6th,12 th,18th and 24 th month,whether there are conflicts in minnesota heart failure quality of life score(MLHFQ),six minute walk test(6MWT),New York Heart Association classification of cardiac function(NYHA),QRS complex(QRS),cardiothoracic ratio(C/T),left ventricular ejection fraction(LVEF),left ventricular end-systole volume(LVESV),left ventricular end-diastolic volume(LVEDV),interventrieular mechanical delay(IVMD)and standard deviation of the peak tissue velocity of the 12 LV segments(Ts-SD-12).Results: There was no statistically significant difference in baseline material between the two groups(P>0.05).Followed up to the 24 th months we found that,compared with the OMT group,6MWT increased(P<0.05),MLHFQ dropped(P<0.05),NYHA class improved(P<0.05),C/T reduced(P<0.05),QRS complex narrowed(P<0.05),LVEF enhanced(P<0.05),LVESV(P<0.05)and LVEDV(P<0.05)shrank in the OMT+CRT group.Compared with preoperative,we found that the IVMD(P<0.05)and Ts-SD-12(P<0.05)were shortened after implantation of CRT.Conclusion: This study shows that cardiac resynchronization therapy with multiple sites left ventricular pacing can improve the clinical symptoms,enhance cardiac function,reverse left ventricular remodeling and restore the coordinated movement of the heart of patients with CHF with relatively wide QRS complex and desynchronization.Patients with CHF with 120ms<QRS<130ms and desynchronization can be appropriately implanted with CRT on the basis of optimal heart failure medical therapy.But to be confirmed by large clinical trials,and explore its safety and effectiveness in combination with the actual clinical situation,provide reference basis for device therapy for patients with CHF with relatively wide QRS complex.