左束支区起搏治疗宽QRS慢性持续性心房颤动合并心力衰竭的疗效分析  

Efficiency analysis of left bundle branch pacing in treating patients with chronic persistent atrial fibrillation featured by wide QRS wave and heart failure

作　　者：钱志宏 乔思芬 蒋俊 孙伟[2] QIAN Zhihong;QIAO Sifen;JIANG Jun;SUN Wei(Liyang Branch of Jiangsu Provincial People′s Hospital, Liyang, Jiangsu, 213300;Jiangsu Provincial People′s Hospital, Nanjing, Jiangsu, 210000)

机构地区：[1]江苏省人民医院溧阳分院,江苏溧阳213300 [2]江苏省人民医院,江苏南京210000

出　　处：《实用临床医药杂志》2018年第23期10-12,共3页Journal of Clinical Medicine in Practice

摘　　要：目的探讨左束支区域起搏对宽QRS波慢性持续性心房颤动(AF)合并心力衰竭的效果。方法对10例慢AF宽QRS波合并心功能不全患者行希氏束旁左束支区起搏及右室心尖部永久起搏器(DDD)起搏治疗。记录手术时间、X线曝光时间及QRS波宽度。于术中、术后7 d、30 d、3月及6月测定起搏电极的参数、检测脑钠肽水平以及应用超声心动图观察左房直径及左室直径、心脏射血分数等指标。结果左束支区起搏电极植入X线曝光时间长于右室心尖部电极植入时间。与术前相比,左束支区起搏患者术后QRS时间明显缩短,术后心功能明显改善,术后脑钠肽显著下降,左房直径及左室直径明显缩小,心脏射血分数显著提高。左束支区起搏参数与心尖部位起搏参数比较无明显差异,术后起搏电极阻抗、感知与起搏阈值较术中明显下降。经过随访,未发现左束支起搏电极有老化及电极脱位现象。结论慢AF宽QRS波合并心功能不全患者可行希氏束旁左束支区起搏,并能明显改善心功能。Objective To investigate the efficiency of left bundle branch pacing in treating patients with chronic persistent atrial fibrillation(AF)featured by wide QRS wave and heart failure.Methods Totally10patients with AF featured by wide QRS wave and cardiac insufficiency were treated with the left bundle branch(LBB)pacing and right ventricular apex pacing(DDD).Operation time,X-ray exposure time and QRS wave width were recorded.The parameters of pacemaker electrodes,brain natriuretic peptide level,left atrial diameter,left ventricular diameter and ejection fraction measured by echocardiography were detected and recorded at the time points of in the operation,7days,30days,3months and6months after operation.Results The time of X-ray exposure was longer in the LBB electrode implantation than that in the right ventricular apical electrode implantation.The QRS duration of the patients with LBB pacing obviously shortened,and the cardiac function obviously improved after operation,the level of BNP significantly decreased after the operation,the diameters of the left atrium and the left ventricle obviously reduced,and the heart ejection fraction significantly improved.There were no significant differences in parameters between the apical pacing and left bundle branch pacing,and the postoperative pacing electrode impedance,perception and pacing threshold were significantly lower than those during the operation.No aging and electrode dislocation of the left bundle pacing electrode were found during the follow-up.Conclusion The LBB pacing is feasible for the patients with AF featured by wide QRS wave and cardiac insufficiency,which can significantly improve cardiac function.

关 键 词：左束支区 起搏 心房颤动 心功能不全 阈值 

分 类 号：R541.6[医药卫生—心血管疾病]