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多位点起搏的研究现状及进展
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Abstract:
心脏再同步化治疗(CRT)是心力衰竭(HF)治疗的基石之一，但是30%~40%的患者没有表现出任何血流动力学参数的改善或者左心室的反向重塑，对CRT的反应取决于许多因素，包括QRS持续时间、左束支传导阻滞形态、左心室(LV)起搏部位和瘢痕组织数量、程控参数、同期药物治疗等。多位起搏(MPP)是一种新的技术，它旨在通过植入单个四极导联并在LV导联的4个电极中的2个电极上进行刺激，来确定比传统的单部位LV刺激更迅速、更具生理性的激活。与双极LV电极相比，在CRT中植入四极LV电极已经显示出无可争议的临床优势，与传统的BIV起搏相比，它还显示出在收缩能力、血流动力学和心肌收缩协调性等方面的显著改善。在本文中，我们阐述了多点起搏(MPP)技术的主要原理及目前临床应用的研究进展，介绍了其主要算法及其应用局限。
Cardiac resynchronization therapy (CRT) is one of the cornerstones of heart failure (HF) treatment, but 30%~40% of patients do not show any improvement in hemodynamic parameters or reverse LV remodeling. The response to CRT depends on many factors, including QRS duration, left bundle branch block mor-phology, left ventricular (LV) pacing site and amount of scar tissue, programming parameters, con-comitant pharmacological therapy, etc. Multipoint pacing (MPP) is a new technique that aims to determine a more rapid and physiological activation than conventional single-site LV stimulation by implanting a single quadripolar lead and stimulating 2 of the 4 electrodes in the LV lead. Implantation of quadripolar LV electrodes in CRT has shown undisputed clinical advantages over bipolar LV electrodes, and has also shown significant improvements in contractility, hemodynamics and coordination of myocardial contraction compared with conventional BIV pacing. In this paper, we describe the main principles of the multipoint pacing (MPP) technique and current research advances in its clinical application, presenting its main algorithms and its application limitations.
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