左束支区域起搏与右心室流入道间隔部起搏的临床对比研究  

Clinical comparison study of peri-left bundle pacing and right ventricular inflow tract septum pacing

作　　者：董士铭 郭成军[1] 戴文龙[1] 方冬平[1] 何东方[1] 卢春山[1] 李巧元[1] 刘旭[1] 林璨璨 Dong Shiming;Guo Chengjun;Dai Wenlong;Fang Dongping;He Dongfang;Lu Chunshan;Li Qiaoyuan;Liu Xu;Lin Cancan(Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases. Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京市心肺血管疾病研究所,100029

出　　处：《中华心律失常学杂志》2019年第2期102-108,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的比较左束支区域起搏与右心室流入道间隔部起搏的电学参数与短期临床效果。方法入选北京安贞医院2017年4月至2018年9月符合心血管植入型电子器械治疗适应证患者60例,分成两组,各30例,均用3830导线,分别植入左束支区域与右心室流入道间隔部。测量、随访与比较两组患者的起搏导线参数、心功能指标、心电参数及不良事件。结果比较两组术中植入电学参数差异无统计学意义。短期随访起搏阈值左束支区域起搏者略低[(0.7±0.3)mV对(0.9±0.4)mV,P=0.021],R波感知[(11.2±6.1)mV对(9.4±5.4)mV,P=0.255],阻抗[(724.0±134.9)Ω对(698.5±147.0)Ω,P=0.485],左心室射血分数[56.3%±9.8%对55.7%±9.1%,(P=0.796)]、左心室舒张末期内径[(49.8±8.0)mm对(50.6±6.5)mm,P=0.685)、二尖瓣反流面积减少程度[(0.1±1.1)cm2对(-0.3±1.0)cm2,P=0.202]、QRS时限[(127.4±32.4)ms对(138.3±33.9)ms,P=0.209]、QT间期[(461.7±38.5)ms对(463.2±35.0)ms,P=0.875]、T波同向性[(9.9±2.0/12)对(9.5±1.8/12),P=0.449]、Tp-e间期[(109.5±33.3)ms对(109.7±19.0)ms,P=0.974]两组差异无统计学意义。结论左束支区域起搏与右心室流入道间隔部起搏比较,术中与短期随访电学参数和临床效果未见显著优势,长期效果有待更多研究。Objective The purpose of this study is to compare the short-term clinical effect and electrical parameters of peri-left bundle pacing (peri-LBBP) and right ventricular inflow tract septal pacing (RVIP). Methods Sixty patients with indications for permanent cardiac pacing and resynchronization therapy were divided into peri-LBBP and RVIP groups in Beijing Anzhen Hospital from April 2017 to September 2018. The Medtronic lead 3830 was used as ventricular pacing lead, and implanted in left ventricular septal sites with left bundle potentials or fascicular potentials in peri-LBBP group and right ventricular inflow tract septal sites closed to distal His-bundle regions without potentials from His-Purkinje conduction system in RVIP group. The lead impedance, R wave amplitude, pacing thresholds, QRS duration, left ventricular ejection fractions (LVEF), and left ventricular end-diastolic diameter (LVEDD) were compared between two groups during procedure and at 3 month follow-up. Results No statistical significance was found between two groups in R wave amplitude[(11.2±6.1) mV vs.(9.4±5.4) mV, P=0.255], lead impedance[(724.0±134.9)Ω vs.(698.5±147.0)Ω, P=0.485], LVEF (56.3%±9.8% vs. 55.7%±9.1%, P=0.796), LVEDD[(49.8±8.0) mm vs.(50.6±6.5) mm, P=0.685], QRS duration [(127.4±32.4) ms vs.(138.3±33.9) ms, P=0.209], QTc [(461.7±38.5) ms vs.(463.2±35.0) ms, P=0.875], and Tp-e [(109.5±33.3) ms vs.(109.7±19.0) ms, P=0.974] except pacing thresholds[(0.7±0.3) mV vs.(0.9±0.4) mV, P=0.021]. Conclusion The efficacy and electrical parameters of peri-LBBP was comparable to RVIP during procedure and in short term follow-up.

关 键 词：束支传导阻滞 心脏起搏 人工 右心室流入道 

分 类 号：R541.7[医药卫生—心血管疾病]