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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Does RV lead positioning provide additional benefit to cardiac resynchronization therapy in patients with advanced heart failure?
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Does RV lead positioning provide additional benefit to cardiac resynchronization therapy in patients with advanced heart failure?

机译：对于晚期心力衰竭患者，RV导联定位是否对心脏再同步治疗有其他好处？

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BACKGROUND AND OBJECTIVES: The left ventricular (LV) stimulation site is currently recommended to position the lead at the lateral wall. However, little is known as to whether right ventricular (RV) lead positioning is also important for cardiac resynchronization therapy. This study compared the acute hemodynamic response to biventricular pacing (BiV) at two different RV stimulation sites: RV high septum (RVHS) and RV apex (RVA). METHODS AND RESULTS: Using micro-manometer-tipped catheter, LV pressure was measured during BiV pacing at RV (RVA or RVHS) and LV free wall in 33 patients. Changes in LV dP/dt(max) and dP/dt(min) from baseline were compared between RVA and RVHS. BiV pacing increased dP/dt(max) by 30.3 +/- 1.2% in RVHS and by 33.3 +/- 1.7% in RVA (P = n.s.), and decreased dP/dt(min) by 11.4 +/- 0.7% in RVHS and by 13.0 +/- 1.0% in RVA (P = n.s.). To explore the optimal combination of RV and LV stimulation sites, we assessed separately the role of RV positioning with LV pacing at anterolateral (AL), lateral (LAT), or posterolateral (PL) segment. When the LV was paced at AL or LAT, the increase in dP/dt(max) with RVHS pacing was smaller than that with RVA pacing (AL: 12.2 +/- 2.2% vs 19.3 +/- 2.1%, P < 0.05; LAT: 22.0 +/- 2.7% vs 28.5 +/- 2.2%, P < 0.05). There was no difference in dP/dt(min) between RVHS- and RVA pacing in individual LV segments. CONCLUSIONS: RVHS stimulation has no overall advantage as an alternative stimulation site for RVA during BiV pacing. RVHS was equivalent with RVA in combination with the PL LV site, while RVA was superior to RVHS in combination with AL or LAT LV site.
机译：背景与目的：目前建议使用左心室刺激部位将导线定位在侧壁上。但是，对于右心室（RV）导联定位对于心脏再同步治疗是否也很重要还知之甚少。这项研究比较了两个不同的RV刺激部位对双心室起搏（BiV）的急性血液动力学反应：RV高间隔（RVHS）和RV顶点（RVA）。方法和结果：33名患者使用微压力计尖端的导管在RV（RVA或RVHS）和左室游离壁的BiV起搏期间测量了左室压力。比较了RVA和RVHS相对于基线的LV dP / dt（max）和dP / dt（min）的变化。 BiV起搏使RVHS的dP / dt（max）升高30.3 +/- 1.2％，而RVA的dP / dt（min）升高33.3 +/- 1.7％，而dP / dt（min）降低11.4 +/- 0.7％ RVHS和RVA中的13.0 +/- 1.0％（P = ns）。为了探索RV和LV刺激部位的最佳组合，我们分别评估了RV定位在前外侧（AL），外侧（LAT）或后外侧（PL）段的LV起搏的作用。当LV调整为AL或LAT时，RVHS起搏的dP / dt（max）的增加小于RVA起搏的AL（AL：12.2 +/- 2.2％vs 19.3 +/- 2.1％，P <0.05; LAT：22.0 +/- 2.7％与28.5 +/- 2.2％，P <0.05）。在单个LV段中，RVHS-和RVA起搏之间的dP / dt（min）没有差异。结论：在BiV起搏期间，RVHS刺激作为RVA的替代刺激部位没有整体优势。 RVHS结合PL LV位点与RVHS等效，而RVA优于AL或LAT LV位点结合的RVHS。

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