摘要
目的分析伴右束支传导阻滞(RBBB)者心脏再同步化治疗(CRT)疗效欠佳的可能影响因素。方法 209例接受CRT的患者,根据其术前QRS波形态分为左束支传导阻滞(LBBB)与RBBB组,比较两组基线临床特征和CRT术后6个月临床心功能、QRS波时限(QRSd)、左室射血分数(LVEF)等心脏超声指标的差异。剔除缺血性心肌病、重度肺动脉高压和QRSd<150 ms的病例后,再次比较两组间CRT疗效差异。结果与LBBB组比较,RBBB组缺血性心肌病占比较高(26.0%vs 11.3%),肺动脉收缩压亦高[(50.14±17.10)mmHg vs(44.27±15.16)mmHg],QRSd则较窄[(152.36±26.84)ms vs(162.92±29.67)ms](P<0.05)。CRT术后6个月,LBBB组临床心功能改善、LVEF的提高均显著优于RBBB组(P<0.05)。而将缺血性心肌病、重度肺动脉高压和QRSd<150ms的病例剔除后,CRT术后两组间各项指标均无差异。结论缺血性心肌病、重度肺动脉高压、相对较窄的QRS波可能是RBBB者CRT疗效欠佳的原因。
Objective To analyze the possible factors resulting in poor response to cardiac resynchronization therapy （CRT） in patients with right bundle-branch block（RBBB）. Methods Two hundred and nine consecutive subjects un- dergoing CRT were stratified into two groups [ left bundle-branch block （LBBB） and RBBB ] based on preprocedural QRS morphology, compared baseline clinical features and clinical outcomes 6 months after CRT between these two groups. Re- sults Compared with the LBBB group, RBBB group demonstrated a higher proportion of ischemic etiology （26.0% vs 11. 3% ）, higher pulmonary artery systolic pressure [ （50.14±17.10）mmHg vs （44.27±15.16）mmHg] and narrower QRS duration （QRSd） [ （152.36±26.84） ms vs （162.92±29.67） ms,P〈0.05 ]. At 6-month follow-up after CRT, the LBBB group showed significantly better clinical improvement and LVEF elevation than RBBB group （P〈0.05）. After the exclu- sion of ischemic cardiomyopathy, severe pulmonary artery hypertesion and those with QRSd〈150 ms, there was no signifi- cant differece between the two groups after CRT. Conclusion Ischemic cardiomyopathy, severe pulmonary artery hy- pertesion and relatively narrow QRSd could be the possible causes of poor response to CRT for RBBB candidates.
出处
《中国心脏起搏与心电生理杂志》
2014年第1期12-15,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
