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背景:心脏再同步治疗(CRT)是治疗充血性心力衰竭(心衰)的有效手段。双心室的有效夺获是术后取得疗效的前提保证
目前多需通过起搏器程控才能判定。目的通过体表心电图图形变化判定CRT术后左心室是否失夺获。方法于北京大学人民医院置入CRT心衰患者73例(男63例
女10例;平均年龄59.3±12.1岁)。入选患者均符合CRT I
I
Ia类适应证
NYHA心功能Ⅱ级
Ⅳ
级
左室射血分数≤35%
QRS波≥120ms(LBBB或IVCD)。每例患者均于CRT术后留取双心室起搏及单纯右室起搏的标准12导联体表心电图
并分析V
1
I
导联R/S比值
判定左心室失夺获情况。结果通过对73例患者的146份心电图分析得出
该方法判定左心室失夺获的敏感性为93.2%(95%CI 84.1%
9
7.5%)
特异性为84.9%(95%CI 74.2%
9
1.9%)
阳性似然比为6.2(95%CI 3.6~10.7)
阴性似然比为0.08(95%CI 0.03~0.19)。并进行亚组分析
对LBBB患者诊断的敏感性为89.6%
特异性为83.3%;对IVCD患者诊断的敏感性为100.0%
特异性为88.0%;对非缺血性心脏病患者诊断的敏感性为91.1%
特异性为83.9%;对缺血性心脏病诊断的敏感性为100.0%
特异性为88.2%;对左室电极置于心侧/心后侧静脉诊断的敏感性为92.7%
特异性为87.3%;心大静脉诊断的敏感性100.0%
特异性为83.3%;心中静脉诊断的敏感性为100.0%
特异性为66.7%;心前侧静脉诊断的敏感性为100.0%
特异性为88.9%。结论通过体表心电图V
1
I
导联R/S比值可快速判定CRT左室是否有效夺获
同时不受术前QRS形态、心衰病因、左室电极植入血管部位等影响
相对简便实用
且该方法敏感性高
特异性较强。
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