左束支区域起搏在慢性心力患者中的应用(附7例报道)  

Application of left bundle branch area pacing in patients with chronic heart failure

作　　者：郭馨竹 周小雪 李霞玲 姜腾勇[1] 张涛[1] 赵华[1] 王云龙[1] 梁卓[1] 韩智红[1] 张烨[1] 任学军[1] GUO Xinzhu;ZHOU Xiaoxue;LI Xialing;JIANG Tengyong;ZHANG Tao;ZHAO Hua;WANG Yunlong;LIANG Zhuo;HAN Zhihong;ZHANG Ye;REN Xuejun(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-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2020年第6期657-661,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨慢性心力衰竭(CHF)患者行左束支区域起搏(LBBAP)的心电图特点、心室同步性改变及可行性。方法:入选7例因慢性心力衰竭且具有心脏再同步化(CRT)治疗指征,行左心室电极置入失败后改行LBBAP的患者。对其进行心电图、心脏超声及起搏器程控随访并对随访资料进行分析。结果:7例患者均试行LBBAP成功。术后心电图提示患者QRS波间期(QRSd)及左心室达峰时间(LVAT)均较术前缩短[QRSd:(165.23±9.13)vs.(125.19±6.03)ms;LVAT:(77.6±6.50)vs.(50.58±6.64)ms]。术后常规超声提示5例患者LVEF、LVIDd、NYHA心功能分级较前提升。6例患者双室间同步性较前好转,7例患者左心室内同步性均较前提升。结论:LBBAP对治疗慢性心力衰竭合并左束支传导阻滞的患者具有可行性,可作为常规CRT左心室电极置入失败后的备选方案。Objective:This study explored the characteristics of electrocardiogram,ventricular synchronization and feasibility of left bundle branch area pacing in chronic heart failure(CHF)patients.Methods:7 CHF patients with decreasing LVEF indicated for CRT were recruited.Left bundle branch block area pacing(LBBAP)was achieved via trans-ventricular septal approach after left ventricular electrode implantation failed.Electrocardiogram,Echocardiogram,cardiac function(NYHA)and pacemaker parameters were evaluate at baseline and follow-up.Results:All patients successfully performed LBBAP.Postoperative ECG showed that the QRS duration(QRSd)and peak left ventricular activation time(LVAT)were narrow than before[QRSd:postoperative(125.19±6.03)vs.(165.23±9.13)ms;LVAT:(50.58±6.64)vs.(77.6±6.50)ms].LVEF,LVIDd and NYHA of 5 patients were improved.Interventricular mechanical delay(IVMD)and the standard deviation of TSI of 12 left ventricular segments(12-Tp-DIF/12-Tp-SD)were shorter during LBBAP than in intrinsic status.Conclusions:LBBAP is feasible for CHF patients with LBBB,which can be another choice for conventional CRT left ventricular electrode implantation failure.

关 键 词：左束支区域起搏 心脏再同步化治疗 心力衰竭 左束支传导阻滞 

分 类 号：R54[医药卫生—心血管疾病]