His束起搏在房室传导阻滞患者中的临床运用  

Clinical application of His bundle pacing in atrioventricular block

作　　者：邹春霞[1] 王小庆[1] 彭长农[1] 钟新波[1] 郭文玉[1] 廖志勇[1] ZOU Chun-xia WANG Xiao-qing PENG Chang-nong ZHONG Xin-bo GUO Wen-yu LIAO Zhi-yong(Department of Cardiology, Sun Yet-sen Cardiovascular Hospital, Shenzhen, Guangdong 518000, China)

机构地区：[1]深圳市孙逸仙心血管医院心内科,广东深圳518000

出　　处：《热带医学杂志》2017年第7期915-918,共4页Journal of Tropical Medicine

基　　金：深圳市卫生计生系统科研项目(201402091)

摘　　要：目的研究His束起搏(HBP)的安全性和有效性以及对房室传导阻滞患者心功能的影响。方法入选53例有常规心脏起搏适应症合并各种程度房室传导阻滞及QRS期限<120 ms、左室射血分数(LVEF)>40%的患者,每位患者首选His束起搏,不成功者改用右室流出道间隔部起搏(RVSP组,41例),其中采用4.1F螺旋导线进行His束起搏成功者共12例(23%),在41例RVSP组患者中随机抽取12例作为对照组,所有患者均植入美敦力Adapta LADDR01起搏器,术后在观察期内关闭MVP功能、Search AV+。观察两组的心室导线参数及左室心功能变化;术后总共随访12个月。结果 HBP组的术后12个月感知及阈值、阻抗与术中比较差异无统计学意义[(3.52±1.14)vs.(3.63±1.16)m V;(1.79±0.62)vs.(1.49±0.4)V;(617.33±59.65)vs.(621.83±68.59)Ω;P>0.05];12例HBP组在随访中未发现心室失夺获现象;术后12个月时与RVSP组比较,HBP组LVEF明显偏高,左室后壁收缩延迟时间(SPWMD)明显减小,差异有统计学意义(P<0.05)。两组6 min步行试验(6MWT)差异无统计学意义(P>0.05)。结论 HBP的安全性和有效性与RVSP无差异;对于窄QRS波、LVEF>40%的房室传导阻滞患者的左室射血分数有保护作用、同时减少左室不同步。Objective To study the effectiveness and safety of His bundle pacing（HBP）,and observe the left ventricular function after a long-term His or para-His bundle pacing in patients with atrioventricularblock（AVB）. Methods 53 patients with different degrees of AVB,a narrow QRS〈120 ms,and a preserved left ventricular ejection fraction（LVEF）〉40%were selected for the study. His bundle pacing was the treatment of choice for all patients. Once HBP was unsuccessful in the operation,right ventricular septal pacing（RVSP）was used. Twelve patients who underwent RVSP were grouped into control group. All the patients received a dual-chamber pacemaker（Adapta L ADDR01,Medtronic Inc.）. The function of management ventricular pacing or Search AV＋ was closed. The pacing parameters and clinical parameters about left ventricular function were recorded after procedure and compared accordingly. All patients were followed up for 12 months. Results There were no differences in pacing parameter in HBP group during follow up . No ventricular capture loss was found in the follow-up in HBP group. After a follow-up of 1 year,heart function indices of HBP group increased compared with those of the RVSP group ,and the differences were all statistically significant （P〈0.05）. And 6 MWT showed no differences between two groups （P〈0.05） .Conclusion HBP is as effective and safe as RVSP. His bundle pacing preserves LVEF and mechanical synchrony as compared with RVSP after 12 months pacing in patients with AVB ,narrow QRS,and LVEF〉0.40.

关 键 词：His束起搏 右室间隔部起搏 房室传导阻滞 心功能 

分 类 号：R541[医药卫生—心血管疾病]