薛聪，华伟，蔡迟，丁立刚，牛红霞，王靖，张澍



心脏再同步治疗对复极离散度和室性心律失常的影响

薛聪，华伟，蔡迟，丁立刚，牛红霞，王靖，张澍

摘要

关键词心律失常；心脏再同步治疗；TpTe间期；跨壁复极离散度

作者单位： 100037 北京市，北京协和医学院 中国医学科学院 国家心血管病中心 阜外医院 心血管疾病国家重点实验室 心律失常诊治中心

Effect of Cardiac Resynchronization Therapy in Patients With Dispersion of Re-polarization and Ventricular Arrhythmia

XUE Cong,HUA Wei,CAI Chi,DING Li-Gang,NIU Hong-xia,WANG Jing,ZHANG Shu.
Center of Cardiac Arrhythmia,Cardiovascular Institute and Fu Wai Hospital,CAMS and PUMC,Beijing(100037),China
Corresponding Author:HUA Wei,Email:drweihua@163.com

Abstract

Objective:To explore the effects of cardiac resynchronization therapy(CRT)in patients with dispersion of re-polarization and ventricular arrhythmia.

Methods:A total of 86 consecutive patents with CRT implantation were enrolled.According to weather absolute value of LVEF increased≥10% from baseline at 6 months after CRT implantation,the patients were divided into 2 groups:Response group and Non-response group,n=43 in each group.Dispersion of re-polarization indexes as QRS duration,QTc interval,TpTe interval and the events of ventricular arrhythmia were compared between 2 groups at different time points after CRT.

Results:①In Response group,compared with pre-operation,QRS duration and TpTe interval were shorter at 1 year and within 24h after CRT implantation,all P<0.05,while the above indexes were similar in Non-response group,all P>0.05.②During 1 year after CRT implantation,the incidences of PVCs and PVC runs in Response group were much less than those in Non-response group,for lgPVCs:(1.78 ± 0.77)vs(2.73 ± 0.61),for lgPVC runs:(0.64 ± 0.48)vs(1.98 ± 0.72),P<0.05.③Multi liner regression analysis demonstrated that TpTe interval within 24h after CRT implantation was an independent predictor for both lgPVCs:(B=0.143,OR=1.154,P=0.001)and lgPVC runs:(B=0.122,OR=1.047,P=0.001).

Conclusion:CRT ventricular reverse remodeling may reduce dispersion of re-polarization and the risk of ventricular arrhythmia,therefore improve the prognosis in relevant patients;TpTe interval within 24h after CRT had the predictive valuefor ventricular arrhythmia.

Key words Arrhythmia;Cardiac resynchronization therapy;TpTe interval;Dispersion of re-polarization

(Chinese Circulation Journal,2016,31:250.)

心脏再同步治疗（CRT）通过改善房室、心室间、心室内的收缩不同步性，改善心力衰竭患者临床症状，降低病死率，是慢性心力衰竭非药物治疗的重大进展。近年来，CRT与室性心律失常的关系逐渐受到重视，CRT治疗是否对复极离散度产生不利影响仍存在争议[1，2]。本研究通过比较CRT术后不同时期的校正的QT间期（QTc间期）、T波峰末间期（TpTe间期）变化，探讨CRT对复极离散度及室性心律失常的影响。

1　资料与方法

研究对象：选取2007-08至2013-08在我院首次行CRT的患者86例，根据术后6个月左心室射血分数（LVEF）是否较基线水平提高10%分为反应组43例（术后6个月LVEF绝对值较基线水平提高≥10%）和无反应组43例（术后6个月LVEF绝对值较基线水平提高<10%）。入选标准：（1）优化药物治疗后，纽约心脏协会（NYHA）心功能分级Ⅲ级或Ⅳ级；（2）LVEF≤35%；（3）QRS时限≥120 ms；（4）首次CRT。排除标准：（1）3个月内有心肌梗死或冠状动脉血管重建；（2）右心室起搏升级为CRT，起搏器依赖，以及持续性心房颤动的患者。

CRT植入术：常规采用经静脉途径植入右心房及左、右心室电极。在放置左心室电极导线之前，先将球囊造影导管延长导引鞘管送入冠状窦并逆行造影显示冠状窦及其分支。理想的靶静脉为侧静脉或侧后静脉，当放置于理想靶静脉有困难时，可将左心室电极导线置入其他左心室分支。心房和右心室电极导线分别固定于右心耳和右心室心尖部。……