心脏再同步化治疗心力衰竭---------现状与进展→苏州大学附属第一医院心内科宋建平CreatePDFwithGO2PDFforfree,ifyouwishtoremovethisline,clickheretobuyVirtualPDFPrinter心脏再同步化治疗•心脏再同步化治疗就是通过植入右室及左室电极，同时起搏左右心室，通过多部位起搏恢复心室同步收缩。•对于心衰伴心室失同步患者，该治疗可增加左室充盈时间，减少间隔矛盾运动，减少二尖瓣反流，改善左室整体功能CreatePDFwithGO2PDFforfree,ifyouwishtoremovethisline,clickheretobuyVirtualPDFPrinter心力衰竭与心室内传导阻滞GeneralHFPopulation1,2ModeratetoSevereHFPopulation3,4,5IVCD>30%IVCD15%1HavranekE,MasoudiF,WestfallK,etal.AmHeartJ2002;143:412-4172ShenkmanH,McKinnonJ,KhandelwalA,etal.Circulation2000;102(18SupplII):abstract22933SchoellerR,AndresenD,ButtnerP,etal.AmJCardiol.1993;71:720-7264AaronsonK,SchwartzJ,ChenT,etal.Circulation1997;95:2660-26675FarwellD,PatelN,HallA,etal.EurHeartJ2000;21:1246-1250CreatePDFwithGO2PDFforfree,ifyouwishtoremovethisline,clickheretobuyVirtualPDFPrinter中到重度心衰病人QRS宽度250stn200eitaP150<120msfor>120mse100bmu46%N5027%53%41%0p))ram(1(2elleLsonsonhoronronScAaAaLamp,etal.PACE1998;2:II-975Aaronsonetal.Circulation1997;95:2660-2667.(1)derivationsample;(2)validationsampleSchoelleretal.AmJCardiol1993;71:720-726CreatePDFwithGO2PDFforfree,ifyouwishtoremovethisline,clickheretobuyVirtualPDFPrinterQRS宽度与机械不同步1008060数收缩同步分收缩不同步百402027%60%70%0s)s)）0m0mms12-15150S(<20>QRS(1S（窄QRQR宽BleekerGB,SchalijMJ,MolhoekSG,etal.RelationshipbetweenQRSdurationandleftventriculardyssynchronyinpatientswithend-stageheartfailure.JCardiovascElectrophysiol.2004;15(5):544-549.CreatePDFwithGO2PDFforfree,ifyouwishtoremovethisline,clickheretobuyVirtualPDFPrinterQRS宽度与死亡率241systolicheartfailure36-MonthMortalitypatientsfollowedforwith95%CIaverageof31months80t60Multivariateanalysisnec40showedIVCD,MVO,andr2e20LVEFwerebestpredictorsPofmortality0ssm60mGradedincreaseinmortality0-10122016withincreasingQRS<1durationQRSDuration(ms)Shamim,etal.Int.J.Cardiol1999;70:171-178CreatePDFwithGO2PDFforfree,ifyouwishtoremovethisline,clickheretobuyVirtualPDFPrin