The study of left ventricular pacing site and clinical benefit in heart failure patients with cardiac resynchronization therapy / 中国医师杂志

ABSTRACT

Objective To investigate the relationship between different left ventricular pacing sites and clinical benefit in heart failure patients treated with cardiac resynchronization therapy (CRT).Methods Clinical data of 52 patients of CRT-P/D (pacing and defibrillation) implantation were collected.According to the left ventricular lead implantation sites,52 cases were divided into anterior wall (10 cases),lateral wall (15 cases),posterior wall (16 cases),and posterior base group (11 cases).The efficacy of CRT was evaluated by Minnesota life quality score,left ventricular function and remodeling index.Results In addition to the anterior wall group,Minnesota life quality score of the other groups were significantly lower than preoperative group (P ＜ 0.05).Compared to pre-CRT implantation,left ventricular end diastolic diameter (LVEDD) of the anterior wall and posterior basal group 3 months after CRT implantation had no statistical significance (P ＞ 0.05);the rest groups were lower than preoperative group (P ＜ 0.05).Left ventricular ejection fraction (LVEF) in posterior wall group was increased after CRT implantation 3 months compared to the preoperative group (P ＜0.05).LVEF in anterior wall group was increased only in the 12 months after CRT implantation (P ＜ 0.05).LVEF in the rest groups was increased comparing to the preoperation at 6 and 12 months postoperation (P ＜0.05).CRT non-response rate in anterior wall group was significantly higher than that in the other groups (P ＜ 0.05).CRT response ratio was significantly increased in side,posterior and posterior basal wall compared to the anterior Wall group (P ＜ 0.05).And there were no statistical significance among side wall,posterior wall and basal wall group (P ＞ 0.05).△ QRSd was higher in side wall,posterior wall and posterior basal group after CRT implantation 3 months than anterior wall group (P ＜ 0.05),△ QRSd in posterior basal group was lower than the other two groups (P ＜0.05).Conclusions Left ventricular electrode should be implanted at the side wall and posterior wall firstly,secondly at the posterior basal wall,and avoid at the anterior wall of the left ventricle.