九分区法左束支区域起搏临床应用的有效性和安全性研究  

Feasibility and safety of new simplified left bundle branch area pacing via nine-partition method

作　　者：张俊蒙[1,3] 张玉霄 陈洁若[1] 王泽峰 祖琳娜 程丽婷 王子雨 王鑫陆 杭霏 吴永全 Zhang Junmeng;Zhang Yuxiao;Chen Jieruo;Wang Zefeng;Zu Linna;Cheng Liting;Wang Ziyu;Wang Xinlu;Hang Fei;Wu Yongquan(Department of Cardiology,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China;Department of Cardiology,First Medical Center,People′s Liberation Army of China General Hospital,Beijing 100853,China;Department of Cardiology,First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]首都医科大学附属北京安贞医院心血管内科,100029 [2]解放军总医院第一医学中心心血管内科,北京100853 [3]清华大学第一附属医院心脏中心内科,北京100016

出　　处：《中华心血管病杂志》2020年第10期848-852,共5页Chinese Journal of Cardiology

摘　　要：目的:评价无多导仪指导的新简化左束支区域起搏(LBBaP)方法(九分区法LBBaP)的有效性和安全性。方法:该研究为回顾性研究。纳入2018年12月1日—2019年12月31日在北京安贞医院拟接受起搏器置入的患者118例。收集患者性别、年龄、主要临床诊断和心电图参数等基本临床信息;行九分区法LBBaP(将右前斜心室影分为9个区,左束支电极初始旋入点在后下1/3区域),在X线影像下,3830电极的位置位于左束支区域,单极起搏QRS波呈右束支阻滞形态,且刺激到左心室激动的峰值时间<90 ms定义为手术成功。记录术中静脉通路穿刺方式、电极参数、手术时间、X线曝光时间、刺激到左心室激动的峰值时间、起搏器类型、手术成功率、手术并发症和术后即刻心电图参数。术后对患者进行随访,记录电极参数和术后并发症情况。结果:118例患者中,男性62例(52.5%),年龄(65.9±13.4)岁;病态窦房结综合征患者49例(41.5%),窦房结和房室结双结病变患者6例(5.1%),房室传导阻滞患者63例(53.4%),心房颤动患者26例(22.0%),心肌病患者20例(16.9%);术前QRS波宽度为(109.21±39.03)ms。其中109例成功行九分区法LBBaP手术,成功率为92.4%。104例(95.5%)为腋静脉穿刺,5例(4.6%)为锁骨下静脉穿刺;手术时间为(80.3±23.0)min,X线曝光时间为(12.29±5.13)min;术后QRS波宽度为(116.36±18.11)ms。左束支电极阈值为(0.92±0.63)V,感知为(10.60±5.04)mV,阻抗为(798.71±194.90)Ω;1 V起搏时,刺激到左心室激动的峰值时间为(67.91±12.15)ms,5 V起搏时为(67.52±12.45)ms;置入单腔起搏器1例(0.9%),双腔起搏器106例(97.3%),三腔起搏器2例(1.8%);术中无血肿、气胸和血胸、电极脱位、感染以及囊袋出血等严重手术相关并发症。共有97例(89.0%)患者完成随访,随访(6.21±2.90)个月,所有患者电极参数稳定,无并发症发生。结论:九分区法LBBaP是一种简单、安全和有效的生理性起搏方法,但其远Objective To investigate the efficacy and safety of left bundle branch area pacing(LBBaP)with the new simplified approach(nine-partition method).Methods A total of 118 patients with clinical indications and received pacemaker implantation from December 1,2018 to December 31,2019 in Beijing Anzhen Hospital were enrolled.LBBaP was performed with the nine-partition method(in the right anterior oblique 30°position,the ventriculogram was divided into nine partitions and the initial implant sites were located in the lower base 1/3 partitions).In X-ray image,the 3830 lead is located in the left bundle branch area,the unipolar pacing QRS wave is in the form of right bundle branch block,and the peak time from stimulation to left ventricular activation<90 ms is defined as successful operation.The clinical characters,such as the methods of venipuncture,electrode parameters,operation duration,fluoroscopy duration,the peak time from stimulation to left ventricular,pacemaker types,surgical success rate,complications,and immediate postoperative ECG parameters were collected.The patients were followed up after the operation,and the electrode parameters and postoperative complications were recorded.Results This study is a retrospective study.There were 62(52.5%)male patients in this cohort,the average age was(65.9±13.4)years old,and there were 49(41.5%)sick sinus syndrome,6(5.1%)abnormal sinus node and atrioventricular node simultaneously,63(53.4%)atrioventricular block,26(22.0%)atrial fibrillation,20(16.9%)cardiomyopathy;the baseline duration of QRS was(109.21±39.03)ms.Successful LBBaP was achieved in 109 patients with“nine-partition method”and the success rate was 92.4%;104 patients(95.5%)were axillary vein puncture,5(4.6%)were subclavian vein puncture;the operation duration was(80.3±23.0)min,the fluoroscopy duration was(12.29±5.13)min;the QRS duration after LBBaP was(116.36±18.11)ms.The threshold of the left bundle branch(LBB)lead was(0.92±0.63)V,the R wave amplitude was(10.60±5.04)mV and the impedance was(798.71±

关 键 词：心脏起搏器 人工 生理性起搏 左束支区域起搏 

分 类 号：R541.7[医药卫生—心血管疾病]