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ȣ - 520877 167 |
| Application of CRT and various clinical outcomes : presentation of single center experience |
| 전남대병원 순환기내과 |
| 고점석, 조정관, 박형욱, 윤남식, 김수현, 강원유, 이민구, 이신은, 박근호, 심두선, 윤연주, 김계훈, 김주한, 안영근, 정명호, 박종춘, 강정채, 박옥규 |
Introduction : Cardiac resynchronization therapy (CRT) is emerging modality for management of refractory heart failure. However, there is insufficient understanding for mechanisms and some debate about predictors of response to therapy. Here, We present our three year experience on application of CRT for patient with various clinical characteristics. Methods : We analyzed 16 patient (male 50%, Age 58±12 yr) who underwent CRT implantation in CNUH from June 2005 to July 2008. Baseline clinical characteristics, laboratory data and ECG were checked. LV systolic function and presence of mechanical dyssnchrony was assessed by echocardiography before and after CRT implantation. We also follow up clinical course of patients and development of complication Results : 10 patients had dilated cardiomyopathy (DCMP) and six patients had ischemic cardiomyocapathy (ICMP). Two patients had history of documented ventricular tachycardia (VT) and one patient admitted with sudden cardiac death (SCD). Mean LV ejection fraction was 26.4±5.0%. Among 16 patients, one patient died due to recurrent ventricular tachycardia and refractory LV failure at two month after implantation. Major complication occurred in one patent who developed left subcalvian vein thrombosis. Three patients complaints of left side chest pain after implantation. Improvement of LV systolic function was observed in nine patients (60%). All of patient had electrical dyssynchrony defined as QRS duration ≥ 120ms. And mechanical dyssynchrony was observed in seven patients when defined as septal to posterior wall motion delay (SPWMD) ≥ 130ms and nine patients when defined as peak ejection time difference > 20ms. LV systolic function was improved in three patients (50%) within patient with SPWMD ≥ 130ms and in five patients (55.6%) within patients with peak ejection time difference > 20ms (55%). There was poor correlation between factors which represent mechanical dyssynchrony. Conclusion : CRT has possibility for new treatment method for refractory heart failure. But it showed uneven clinical outcomes until now. New parameters for identification of responders to CRT is needed
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