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检测心脏再同步治疗中左室起搏失夺获的心电图标准

An electrocardiogram-based algorithm to detect loss of left ventricular capture during cardiac resynchronization therapy

作     者:Ammann P. Sticherling C. Kalusche D. 孙凯 

作者机构:Department of Internal Medicine Division of Cardiology Kantonsspital St. Gallen CH-9007 St. Gallen Switzerland Dr. 

出 版 物:《世界核心医学期刊文摘(心脏病学分册)》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期:2005年第1卷第11期

页      面:18-19页

学科分类:0831[工学-生物医学工程(可授工学、理学、医学学位)] 08[工学] 1010[医学-医学技术(可授医学、理学学位)] 10[医学] 

主  题:夺获 再同步 左束支传导阻滞 右室心尖部 波形变化 似然比 大学医院 阴性结果 特异性 

摘      要:Background: Loss of left ventricular capture in patients with cardiac resynchronization devices may account for worsening heart failure and can be difficult to diagnose without a programmer. Objective: To determine whether distinct morphologic changes on the surface electrocardiogram indicate loss of left ventricular capture. Design: After analysis of the R-S spike ratio in the 12-lead electrocardiogram during right ventricular and biventricular pacing in 10 patients, an algorithm to detect loss of left ventricular capture was developed. Setting: University hospital. Patients: 54 patients with a cardiac resynchronization device and underlying left bundle-branch block. Measurements: Leads V1 and I of a 12-lead electrocardiogram were assessed after biventricular pacing was confirmed and after the device was programmed to right ventricular pacing only(simulating loss of left ventricular capture). Results: The sensitivity of the algorithm to correctly identify loss of left ventricular capture was 94%(95%CI, 88.2%to 97.7%), and the specificity was 93%(CI, 86.3%to 95.8%). The likelihood ratio of a positive test result was 12.8(CI, 6.443 to 23.310), and the likelihood ratio of a negative test result was 0.06(CI, 0.024 to 0.137). Limitations: The algorithm was tested in patients in whom the right ventricular electrode was placed in the apex of the right ventricle only. Conclusion: Presence of biventricular capture-the prerequisite for successful cardiac resynchronization therapy-and loss of left ventricular capture can be accurately detected by an algorithm based on analysis of the R-S ratio on leads V1 and I of the surface electrocardiogram.

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