中文摘要：

目的：探讨心电图QRS时限和形态对心脏再同步治疗（CRT）效果的影响。方法：入选植入CRT/D装置的患者272例,依据术前心电图QRS时限将其分为轻度延长（120-149ms）组、中度延长（150-179ms）组和重度延长（≥180ms）组,比较3组患者CRT反应情况;依据左束支阻滞（LBBB）诊断新标准,将患者分为真性LBBB组和假性LBBB组,比较两组患者CRT反应情况。结果：QRS时限中度（62.8%）、重度（54.3%）延长组CRT反应率优于轻度（49.6%）延长组;真性LBBB组CRT反应率优于假性LBBB组（64.3%︰52.9%）。多因素分析显示宽QRS波和真性LBBB与CRT反应率增加有关。结论：QRS时限中、重度延长组患者CRT反应率优于轻度延长组,而中度和重度延长组患者间CRT反应率无明显差别;真性LBBB组CRT反应率优于假性LBBB组。

英文摘要：

Objective：To evaluate the impact of QRS duration and morphology on response to cardiac resynchronization therapy（CRT）.Method：A total of 272 patients received CRT/D implantation were enrolled.All patients were divided into mild prolonged（QRSd：120-149ms）,moderate prolonged（QRSd：150-179ms）,and severe prolonged（QRSd：≥180ms）group according to QRS duration.Furthermore,patients were divided into true LBBB and false LBBB group according to QRS morphology.A comparison was made according to different QRS duration and morphology.Result：Moderate and severe prolonged group（QRSd≥150ms）achieved better reverse remodeling and CRT response（62.8% or 54.3% vs.49.6%）,but there was no significant difference between moderate and severe prolonged group（59.3% vs.60%）.Moreover,compared with false LBBB group,true LBBB group had superior CRT response（64.3% vs.52.9%）.In multivariable analyses,QRSd≥150ms and true LBBB were emerged as powerful predictor of CRT response.Conclusion：CRT response is better in patients with preimplant QRSd of≥150ms and or true LBBB but worse in patients with a QRSd of 120-149ms and or false LBBB.