永久左束支起搏心脏再同步治疗在左束支阻滞患者远期疗效的初步研究  

Long-term benefits and feasibility of permanent left bundle branch pacing in patients with left bundle branch block

作　　者：吴圣杰[1] 苏蓝[1] 项文豪 郑茹洁 蔡蒙醒 徐蕾[1] 方英[1] 王良国[1] 黄伟剑[1] Wu Shengjie;Su Lan;Xiang Wenhao;Zheng Rujie;Cai Mengxing;Xu Lei;Fang Ying;Wang Liangguo;Huang Weijian(Department of Cardiology,the First Affiliated Hospital of Wenzhou Medical University,the Key Lab of Cardiovascular Disease of Wenzhou,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院心内科,温州市心血管病重点实验室,325000

出　　处：《中华心律失常学杂志》2019年第5期399-404,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：浙江省重点研发项目(2019C03012);温州市科技局重大科技项目(ZS2017010);温州市基础性科研项目(Y20180143)。

摘　　要：目的评价左束支起搏(LBBP)在左束支传导阻滞(LBBB)患者中应用的可行性、安全性、同步及心功能改善。方法收集2014年4月至2017年8月在温州医科大学附属第一医院心内科植入永久性LBBP,且随访时间超过2年的LBBB患者。讨论植入方法的可行性,分析与评估左束支夺获的电学特性及临床疗效,主要指标为QRS时限、阈值、感知、心功能,超声心动图结果及导线相关并发症。结果共入选成功植入永久LBBP 11例,平均年龄(71.0±12.4)岁,年龄范围41~91岁。自身QRS时限为(164.6±15.7)ms,起搏QRS时限为(113.1±17.1)ms。随访(32.5±12.1)个月。急性期阈值为(0.65±0.21)V/0.5 ms,感知为(8.3±1.7)mV,在随访2年时,阈值及感知保持稳定,分别为(0.70±0.16)V/0.5 ms,(9.1±2.7)mV。其中7例左心室射血分数(LVEF)<50%,LVEF从基线的34.0%±8.2%提升到末次随访的63.4%±9.8%,左心室收缩末期容积从(127.6±65.3)ml缩小至(37.2±13.9)ml,心功能(NYHA分级)从(3.3±0.7)级恢复至(1.3±0.5)级(P<0.05)。术后未观察到导线脱位、失夺获、阈值增高及心力衰竭再住院、死亡等不良事件。结论永久LBBP纠正LBBB,实现左心室再同步,其远期阈值稳定、感知良好、安全可靠,显著改善患者心功能,可作为双心室起搏或希氏束起搏的补充与替代。Objective To assess the long-term feasibility,safety and effectiveness of permanent left bundle branch pacing(LBBP)in patients with left bundle branch block(LBBB).Methods Patients with LBBB who had implanted LBBP more than 2 years from Department of Cardiology,the First Affiliated Hospital of Wenzhou Medical University were included.The feasibility of the implantation method,the electrical characteristics and clinical efficacy of the left bundle branch were analyzed and evaluated.The main outcome measures were characteristics,QRS complex,pacing parameters,echocardiographic measurements,and New York Heart Association(NYHA)functional classification and electrode-related complications.Results A total of 11 patients were included,with mean age of(71.0±12.4)years and intrinsic QRS duration of(164.6±15.7)ms.Of them,6(54.5%)were selective LBBP and 5 were non-selective,with the paced QRS duration of(113.1±17.1)ms.The average follow-up duration was(32.5±12.1)months.The acute threshold and R-wave amplitude were(0.65±0.21)V/0.5 ms and(8.3±1.7)mV,respectively,which remained stable during the follow-up.In 7 patients who had left ventricular ejection fraction(LVEF)<50%,the LVEF improved from 34.0%±8.2%to 63.4%±9.8%,left ventricular end-systolic volume decreased from(127.6±65.3)ml to(37.2±13.9)ml and NYHA improved from 3.3±0.7 to 1.3±0.5(P<0.05).No adverse events such as electrode dislocation,loss of capture,increased threshold,perforation and stroke,rehospitalization for heart failure or death were observed.Conclusion Permanent LBBP can achieve LV synchrony in LBBB patients and is safe and effective during long-term follow-up.

关 键 词：希氏束 心脏再同步治疗 束支传导阻滞 

分 类 号：R54[医药卫生—心血管疾病]