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目的 本研究旨在评估心脏再同步治疗除颤器(CRT-D)植入术后心脏逆重构对室性心律失常(VA)的影响.方法 本研究回顾性分析2014年6月到2017年6月因心力衰竭于安徽省立医院心内科植入CRT-D的患者,电学逆重构定义为术后12个月自身QRS时限与术前相比缩小≥10 ms,机械逆重构定义为术后12个月左心室收缩末期容积(LVESV)缩小≥15％.根据定义将患者分为单纯电学逆重构组(ERR组),单纯机械逆重构组(MRR组),电学、机械逆重构均未发生组(ERR-MRR-组),电学、机械逆重构均发生组(ERR+MRR+组).比较各组随访期间VA、抗心动过速起搏(ATP)、电除颤等指标的差异.结果 研究纳入222例患者,其中ERR组31例、MRR组62例、ERR-MRR-组59例、ERR+MRR+组70例,4组患者在基线资料方面差异无统计学意义.随访显示,ERR+MRR+组与ERR组相比,VA[(0.34±1.09)次/人对(1.29±2.42)次/人,P=0.04]、VA负荷[(0.14±0.42)次/人年对(0.51±0.98)次/人年,P=0.03]、ATP[(0.59±1.71)次/人对(1.74±3.19)次/人,P=0.04]差异有统计学意义;而电除颤[(0.13±0.38)次/人对(0.32±0.60)次/人,P=0.06]、电除颤负荷[(0.06±0.22)次/人年对(0.16±0.24)次/人年,P=0.07]、ATP负荷[(0.26±0.79)次/人对(0.72±1.37)次/人,P=0.05]差异无统计学意义.另外,ERR组与非ERR组相比,VA负荷[(0.51±0.98)次/人年对(1.34±1.84)次/人年,P=0.04]差异有统计学意义,VA[(1.29±2.42)次/人对(3.42±5.05)次/人,P=0.05]、电除颤[(0.32±0.60)次/人对(0.76±1.07)次/人,P=0.06]、电除颤负荷[(0.16±0.24)次/人年对(0.33±0.49)次/人年,P=0.10]、ATP[(1.74±3.19)次/人对(4.52±6.89)次/人,P=0.07]、ATP负荷[(0.72±1.37)次/人年对(1.78±2.49)次/人年,P=0.05]差异无统计学意义;MRR组与非MRR组相比,VA、VA负荷、ATP、ATP负荷、电除颤、电除颤负荷差异均无统计学意义.结论 单纯机械逆重构不能降低VA负荷;单纯电学逆重构能够一定程度降低VA负荷;电学、机械逆重构均发生能够更进一步降低VA负荷.

Objective The aim of this study was to evaluate the effect of cardiac reverse remodeling on ventricular arrhythmia (VA) after cardiac resynchronization therapy defibrillator (CRT-D) implantation.Methods The patients received CRT-D who had complete follow-up data in Anhui Provincial Hospital from June 2014 to June 2017 were included.Electrical reverse remodeling(ERR) was defined as baseline intrinsic QRS duration (iQRSd) shortening ≥ 10 ms 12 months after CRT-D implantation,and mechanical reverse remodeling(MRR) was defined as a decrease in left ventricular end-systolic volume(LVESV) ≥ 15％ after at least 12 months after CRT-D implantation.According to the definition,patients were classified as ERR only group,MRR only group,ERR-MRR-group,and ERR+MRR+group.VA,implantable cardioverter defibrillator (ICD) shocks treatment,antitachycardia pacing therapy (ATP),and other indicator of the four groups were compared.Results A total of 222 patients enrolled in the study,ERR only group (n =31),MRR only group(n =62),non-responder (ERR-MRR-group,n =59),and ERR+MRR+group (n =70),and there were no significant differences in baseline characteristics among the four groups.Follow-up showed that compared with the ERR group,the ERR+MRR+ group had lesser VA per person [(0.34± 1.09) vs.(1.29±2.42),P=0.04] and lighter VA burden per person-year [(0.14±0.42) vs.(0.51±0.98),P=0.03],lesser ATP per person [(0.59 ± 1.71) vs.(1.74 ± 3.19),P =0.04],the difference was statistically significant.The shock per person [(0.13 ± 0.38) vs.(0.32 ± 0.60),P =0.06],shock burden per person-year [(0.06±0.22) vs.(0.16± 0.24),P =0.07] and the ATP burden per person-year [(0.26 ± 0.79) vs.(0.72 ±1.37),P =0.05] were not statistically significant.In addition,the VA burden per person-year [(0.51 ±0.98) vs.(1.34± 1.84),P=0.04] was statistically significant lighter in the ERR group than that in the nonERR group.While VA per person[(1.29±2.42) vs.(3.42±5.05),P=0.05],shock per person[(0.32±0.60) vs.(0.76±1.07),P=0.06],shock burden per person-year[(0.16±0.24) vs.(0.33±0.49),P=0.10],ATP per person [(1.74± 3.19) vs.(4.52± 6.89),P =0.07] and ATP burden per person-year[(0.72± 1.37) vs.(1.78±2.49),P=0.05] were not statistically significant.There were no significant differences in VA,VA burden,ATP,ATP burden,shock,shock burden between the MRR group and non-responder.Conclusion Only mechanical reverse remodeling can not reduce the VA burden.Electrical reverse remodeling can reduce the VA burden.Both electrical reverse remodeling and mechanical reverse remodeling can further reduce the burden.