[Improvement of the technique of positioning the endocardial electrodes of the cardiac contractility modulation device in patients with CHF with reduced ejection fraction and atrial fibrillation].

Pub Date : 2024-07-30 DOI:10.26442/00403660.2024.07.202782

A A Safiullina, T M Uskach, O V Sapelnikov, M A Saidova, A A Ansheles, V B Sergienko, V A Amanatova, I R Grishin, D I Cherkashin, R S Akchurin, S N Tereschenko

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Abstract

Aim: To evaluate the efficacy and safety of the advanced technique for positioning the endocardial electrodes of a cardiac contractility modulation (CCM) device.

Materials and methods: The CCM system was implanted in 100 patients, of which 60 CCM electrodes were positioned in the most optimal zones of myocardial perfusion, in particular, in the zone of the minor focal-scar/fibrotic lesion (the Summed Rest Score of 0 to 1-2, the intensity of the radiopharmaceutical at least 30%), and in 40 patients according to the standard procedure. Before the implantation of the CCM system, 60 patients underwent tomography (S-SPECT) of the myocardium with ^99mTc-methoxy-isobutyl-isonitrile at rest to determine the most optimal electrode positioning zones and 100 patients underwent transthoracic echocardiography at baseline and after 12 months to assess the effectiveness of surgical treatment.

Results: Improved ventricular electrode positioning technique is associated with the best reverse remodeling of the left ventricular myocardium, especially in patients with ischemic chronic heart failure, with less radiation exposure to the surgeon and the patient, and without electrode-related complications.

Conclusion: At the preoperative stage, it is recommended to perform a synchronized single-photon emission computed tomography of the myocardium with ^99mTc-methoxy-isobutyl-isonitrile at rest before implantation of the CCM device to assess the presence of scar zones/myocardial fibrosis in the anterior and inferior septal regions of the interventricular septum of the left ventricle, followed by implantation of ventricular electrodes in the zone of the minor scar/fibrous lesion, which will allow to achieve optimal stimulation parameters, increase the effectiveness of CCM therapy, reduce the radiation exposure on medical personnel and the patient during surgery.

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[射血分数降低的心房颤动患者心肌收缩力调节装置心内电极定位技术的改进]。

目的：评估先进的心脏收缩力调节（CCM）装置心内膜电极定位技术的有效性和安全性：在 100 名患者中植入了 CCM 系统，其中 60 名患者的 CCM 电极定位在心肌灌注的最佳区域，尤其是轻微病灶瘢痕/纤维化病变区域（总静息评分为 0 至 1-2，放射性药物强度至少为 30%），另有 40 名患者的 CCM 电极按照标准程序定位。在植入 CCM 系统前，60 名患者在静息状态下接受了 99mTc- 甲氧基异丁基异腈心肌断层扫描（S-SPECT），以确定最佳电极定位区，100 名患者在基线和 12 个月后接受了经胸超声心动图检查，以评估手术治疗的效果：结果：改进的心室电极定位技术与左心室心肌的最佳反向重塑有关，特别是在缺血性慢性心力衰竭患者中，对外科医生和患者的辐射暴露更少，并且没有与电极相关的并发症：结论：在术前阶段，建议在植入 CCM 装置前，用 99mTc 甲氧基异丁基异腈在静息状态下对心肌进行同步单光子发射计算机断层扫描，以评估左心室室间隔前区和下隔区是否存在瘢痕区/心肌纤维化、然后在轻微瘢痕/纤维病变区植入心室电极，这样可以获得最佳刺激参数，提高 CCM 治疗的效果，减少手术过程中对医务人员和患者的辐射。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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