左束支区域起搏室间隔穿孔的影像与电学特征  

Image and electrical characteristics of septal perforation in left bundle branch pacing

作　　者：林璨璨 戴文龙[1] 方冬平[1] 何东方[1] 李巧元[1] 郭成军[1] Lin Cancan;Dai Wenlong;Fang Dongping;He Dongfang;Li Qiaoyuan;Guo Chengjun(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,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,100029

出　　处：《中华心律失常学杂志》2020年第4期410-413,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的评估左束支区域起搏术后室间隔穿孔的影像学与电学特征,探讨规避室间隔穿孔的方法。方法选取2018年1月至2019年4月北京安贞医院心内科因缓慢性心律失常植入起搏器的患者40例,术中使用主动固定导线植入右心室中位间隔部,行左束支区域起搏。术后超声心动图及CT检查有无室间隔穿孔,分为穿孔组(7例)及非穿孔组(33例),比较两组术中心室导线起搏阈值、阻抗、感知功能等指标。结果穿孔组与非穿孔组患者性别、年龄、疾病种类构成差异无统计学意义。两组术中导线感知差异无统计学意义,穿孔组的导线阻抗趋向低于非穿孔组[(707.000±170.321)Ω对(822.727±225.071)Ω,P=0.208],穿孔组的导线阈值略高于非穿孔组[(0.843±0.310)mV对(0.797±0.303)mV,P=0.719],但差异无统计学意义。结论术中感知、阈值、阻抗等参数不足以判定是否发生室间隔穿孔,需寻找更有效方法以协助判断,提高左束支区域起搏导线植入的安全性。Object To discuss the image and electrical characteristics of septal perforation in left bundle branch pacing and how to avoid the septal perforation.Methods Forty patients in department of cardiology of Beijing Anzhen Hospital with bradyarrhythmia who underwent permanent pacemaker implantation between January 2018 and April 2019 were selected.Then Medtronic 3830 electrode was implanted into their middle septum of the right ventricular,performed the left bundle branch area pacing,and measured the pacing threshold,impedance and sensing function of ventricular electrode during the operation.After operation,echocardiography and cardiac CT scans were performed.According to the presence or absence of interventricular septal perforation,patients were divided into perforation group(7 patients)and non-perforation group(33 patients),then compared the difference of the above parameters between the two groups.Results There were no significant differences in gender,age and disease types between perforation group and non-perforation group.There was no significant difference in wire perception between the two groups.The wire impedance of perforated group tends to be lower than that of non perforated group[(707.000±170.321)Ωvs.(822.727±225.071)Ω,P=0.208].Meanwhile the pacing threshold in perforated group was slightly higher than that in non perforated group[(0.843±0.310)mV vs.(0.797±0.303)mV,P=0.719].However,the differences ofimpedance and threshold between the groups were not statistically significant.Conclusion The parameters during operation such as perception,threshold and impedance are not enough to determine whether there is a ventricular septal perforation.We need to find more effective ways to evaluate the presence of interventricular septal perforation,improving the safety of left bundle branch area pacing.

关 键 词：心脏起搏 人工 左束支起搏 室间隔穿孔 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]