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重症心力衰竭(心衰)患者常常由于心室内传导障碍引起左室非同步收缩,这种不协调的低效率收缩方式使泵功能降低。双室起搏的心脏再同步治疗(CRT)是从2个方向对左室起搏,从而纠正这种非同步收缩,改善血流动力学。CRT可以显著改善重症心衰患者的自觉症状、运动耐量和生活质量(QOL),长期进行可以逆转左室重构,明显减少心衰住院率和死亡率。CRT的适应证是NYHAⅢ/Ⅳ级,经药物治疗没有改善,左室搏出率≤35%,QRS波≥130msec的病例,有效率约70%。无效的原因包括:①左室电极位置不正确;②晚期心衰;③有左室游离壁的透壁性梗死灶;④心室非同步收缩程度较轻。该装置的进步非常显著,具有除颤功能的CRT-D已占主流,正在增加可以监测肺淤血等机体信息的功能。
Patients with severe heart failure (CHF) often experience non-synchronous left ventricular systolic contraction due to intra-ventricular conduction disturbances, a pattern of uncoordinated, inefficient contraction that reduces pump function. Cardiac resynchronization therapy (CRT) of biventricular pacing is a pacing of the left ventricle from two directions to correct this non-synchronous contraction and improve hemodynamics. CRT can significantly improve the symptoms, exercise tolerance and quality of life (QOL) in patients with severe heart failure, long-term can reverse left ventricular remodeling, significantly reduce the hospitalization rate and mortality of heart failure. CRT indications are NYHA class III / IV, no improvement after drug treatment, left ventricular stroke rate ≤ 35%, QRS wave ≥ 130msec cases, the effective rate of about 70%. Invalid reasons include: ① left ventricular electrode position is not correct; ② advanced heart failure; ③ left ventricular free wall transmural infarction; ④ ventricular systolic less degree of contraction. The advancement of this device is significant, and the CRT-D with defibrillation has become mainstream and is adding the ability to monitor body tissue information such as lung congestion.