【導(dǎo)讀】心律失常，尤其是AF，頻發(fā)室早。藥物治療方案無效或未及時(shí)調(diào)整。不能及時(shí)發(fā)現(xiàn)心衰病情變化。肺部充血的臨床表現(xiàn)常出現(xiàn)較晚，不易被察覺，CRT起搏≤92%比>92%在首次植入6月的NYHA心功能。CRT起搏在98-99%與93-97%起搏患者獲益相同。雙心室起搏百分比增加，心衰住院或全因死亡事件減少。21%CRT患者有房性心律失常，29%患者既往有AT，17%. 在隨訪中發(fā)生（28周)，CRT對心房機(jī)械重構(gòu)和功能改變可能有益。房顫快室率影響CRT再同步治療，加重心衰惡化。及時(shí)監(jiān)測到AF發(fā)作有助于立即采取心衰防范措施，決定是。頻發(fā)室早是聯(lián)合事件和心血管事件（AMI或死。頻發(fā)室早伴有HRV降低是心源性猝死的預(yù)測因子。無室早或室早偶發(fā)提示心功能狀況改善，室早頻發(fā)提示。靜息心室率增加是冠心病，心血管疾病，癌癥或所有原。夜間心室率增加是重要的預(yù)測心衰急性失代償發(fā)作的獨(dú)。心衰加重時(shí)，心率明顯逐漸升高。住院或死亡的心衰患者HRV偏低。事件發(fā)作3周前HRV下降。CRT患者低HRV與高死亡率和高心衰住院風(fēng)險(xiǎn)呈獨(dú)立相

　　

【正文】 or two suitable implantation sites for the LV lead were selected. Following atrial, RV, and LV catheter positioning, a micromanometer catheter was placed in the ascending aorta ?At each LV lead position, a pacing protocol was performed with biventricular pacing in DDD mode, AV delay 100 ms, and VV delay 0 ms. pacing rates 80, 100, 120, 140, and 40 ppm ?correlation between SV and intracardiac SZ has been investigated during a biventricular pacing ?Different CS lead implantation sites have been used, but RV lead position was always apical Patient LV position SZ–SV SZ–PP R σ (%) R σ (%) 1 Apical * 17 * 17 1 Medial lateral * 17 * 17 2 Medial posterior * 15 * 14 2 Medial anterior * 20 * 21 3 Medial lateral * 16 * 22 3 Medial posterior * 12 * 13 4 Medial lateral * 6 * 4 4 Medial anterior * 15 * 17 5 Medial posterior * 31 * 32 6 Medial posterior * 23 * 24 6 Medial posterior * 29 * 28 7 Medial lateral * 14 * 13 7 Apical * 66 * 66 8 Medial lateral * 26 * 24 9 Basal anterior . 46 . 50 10 Basal lateral * 9 * 9 11 Medial lateral . 34 . 33 12 Basal lateral * 9 * 9 13 Medial posterior * 11 * 12 14 Medial posterior * 8 * 9 Mean 21 22 SD 15 15 Bocchiardo M et al. Europace 2020。12:702707 LV lead positions and correlation results for all patients SZ, stroke impedance, SV, stroke volume, PP, pulse pressure, R, correlation coefficient Example of raw data recording (ECG, surface electrocardiogram。 AortaP, aortic blood pressure。 Z, intracardiac impedance Bocchiardo M et al. Europace 2020。12:702707 Haemodynamic effects of overdrive pacing Bocchiardo M et al. Europace 2020。12:702707 linear correlation coefficients R with grouped for left ventricular lead position Bocchiardo M et al. Europace 2020。12:702707 Conclusion In HF patients, a strong correlation between changes in intracardiac impedance and LV SV was found. Typical LV lead implant positions have been tested and all appear to be suitable for this method of LV volume monitoring. Potential value of automated daily screening of CRTD diagnostics for prediction of major cardiovascular events: results from HomeCARE 研究目的 在患者出現(xiàn)心衰相關(guān)事件同時(shí)長期記錄經(jīng)胸阻抗 通過回溯評(píng)估敏感性和假陽性率來完善阻抗監(jiān)測算法 進(jìn)一步提高心衰監(jiān)測系統(tǒng)表現(xiàn) 研究設(shè)計(jì) 多中心，國際性 終點(diǎn)事件驅(qū)動(dòng) Eventdriven (35 HF相關(guān)事件 ) 預(yù)期 60 HF事件 預(yù)期 600 所有事件 研究時(shí)間表 首例植入 : 入組 : – 隨訪 : 3, 9, 15, 21 月 最后病例結(jié)束 : ~ . 入組患者 ~300 患者 , NYHA IIIV LVEF ? 35% 高心衰住院風(fēng)險(xiǎn) Lumax 540 (VR,DR,HF) Eur J Heart Fail. 2020。 13(9): 1019–1027 HomeCARE II Measurement of Thoracic Impedance 心衰加重住院 Hospitalization due to WHF IngrowthPhase (wound healing) 失代償前 ITI下降 治療 : 增加利尿劑 ? 體重下降 ~10 kg 28 days Eur J Heart Fail. 2020。 13(9): 1019–1027 HomeCARE II急性失代償性心衰 ICD 隨訪后住院 Eur J Heart Fail. 2020。 13(9): 1019–1027 HomeCARE II 多次心衰加重 WHFHospitalizations 1st 2nd 3rd Reha IngrowthPhase Eur J Heart Fail. 2020。 13(9): 1019–1027 In pts treated with CRTD devices capable of daily transmission of their diagnostic data via Home Monitoring， this tool may increase pts’ quality of life and reduce morbidity, mortality, and health economic burden, it now warrants prospective studies 小 結(jié) ? CRT已成為治療心衰患者的重要手段，但仍有部分患者無應(yīng)答或由于術(shù)后管理不充分而導(dǎo)致心血管事件 ?CRT的心力衰竭監(jiān)護(hù)系統(tǒng)相比傳統(tǒng)門診隨訪模式能夠及時(shí)識(shí)別患者心衰病情變化和監(jiān)測 CRT治療的有效性 ?不斷發(fā)展的心衰監(jiān)測工具將進(jìn)一步幫助臨床醫(yī)生早期預(yù)測心衰加重，更好地降低患者住院率和死亡率