希氏束起搏在需要高比例心室起搏的窄QRS波群患者中应用探讨  

The application of His bundle pacing in patients with narrow QRS complex who required high percentage of ventricular pacing

作　　者：王娜[1] 梁延春[1] 于海波[1] 梁智豪 徐白鸽[1] 高阳[1] 焉晓蕾 刘荣[1] 许国卿[1] 王祖禄[1] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016 [2]上海交通大学医学部,200025

出　　处：《中国心脏起搏与心电生理杂志》2017年第5期401-407,共7页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：辽宁省科学技术计划面上项目(No.2015020406;No.2015020418)

摘　　要：目的探讨希氏束(HB)起搏(HBP)在需要高比例心室起搏的窄QRS波群患者的应用。方法研究对象为在沈阳军区总医院行HBP手术的需要高比例心室起搏的窄QRS波群患者,统计HBP手术的成功率,随访观察HBP阈值、起搏百分比及起搏导线稳定性。结果 63例患者,心率[46.9±6.7(31~73)]次/分,QRS波时限为[89.6±10.4(70~118)]ms,心房颤动(AF)伴缓慢心室率24例,完全房室传导阻滞(AVB)39例。HBP手术成功率为79.4%(50/63),其中AF伴缓慢心室率患者的成功率为91.7%(22/24),完全AVB患者的成功率为71.8%(28/39)。单一术者前30例HBP手术学习阶段成功率为70.0%(21/30);后33例成功率为87.9%(29/33)。成功HBP手术的X射线曝光时间为(6.2±3.6)min。25例植入了右室起搏备份导线。术后不同时期随访,HBP百分比平均大于99%(85%~100%)。术后6个月随访,仅1例患者HBP阈值升高到2.5V/0.5ms。随访期内所有患者无起搏导线移位,无HBP手术相关并发症。结论在需要高比例心室起搏的窄QRS波群患者中进行HBP可行性好且术后起搏安全稳定。Objective To investigate the application of His bundle （HB） pacing （HBP） among patients with nar- row QRS complex who required high percentage of ventricular pacing. Methods Patients with narrow QRS com- plex who required high percentage of ventricular pacing and underwent an attempt at permanent HBP in General Hospital of Shenyang Military Region were enrolled in this study. The success rate and the percentage of HBP, the threshold and stability of HBP lead were analyzed. Results Among 63 patients, atrial fibrillation with slow ven- tricular rate was diagnosed in 24 patients and complete atrioventricular block was diagnosed in the other 39 patients. The average heart rate was [46.9 ：[： 6.7 （31 -- 73） ] beats/min and the duration of QRS complex was [-89.6 ! 10.4 （70 --118） ]ms. The total success rate of HBP was 79.4% （50/63）, 91.7% （22/24） in patients with atrial fibrillation and slow ventricular rate and 71.8% （28/39） in patients with complete atrioventricular block. The success rate of HBP during HBP learning period in the first 30 procedures was 70.0% （21/30） and ascends to 87.9% （29/33） in the latter 33 procedures. Mean fluoroscopy time of a success HBP procedure was （6.2 ± 3.6） rain. Backup right ventric- ular pacing lead was implanted in 25 patients. The average percentage of HBP was more than 99 % （ 85%- 100 % ）. Elevation of HBP threshold （value of 2.5 V/0.5 ms） was observed in only one patient at six months follow-up. There was no lead dislodgment during follow-up and no complication related to HBP procedure. Conclusion HBP in patients with narrow QRS complex who required high percentage of ventricular pacing is feasible and is safe and stable after procedure.

关 键 词：心血管病学 希氏束 心动过缓 起搏 QRS波群 可行性 

分 类 号：R541.72[医药卫生—心血管疾病] R318.11[医药卫生—内科学]