希氏束起搏术中需要临时心脏起搏保护的适应证分析  

Indications for temporary cardiac pacing during His-bundle pacing

作　　者：徐白鸽 焉晓蕾 于海波 王娜 武敏 许国卿 高阳 刘荣 梁延春 Xu Baige;Yan Xiaolei;Yu Haibo;Wang Na;Wu Min;Xu Guoqing;Gao Yang;Liu Rong;Liang Yanchun(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]中国人民解放军北部战区总医院心血管内科,沈阳110016

出　　处：《中华心律失常学杂志》2020年第5期482-486,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家重点研发计划(2016YFC0900904、2016YFC0900905);辽宁省自然科学基金(20180550901)。

摘　　要：目的探讨希氏束起搏(HBP)术中需要临时心脏起搏(TCP)保护的适应证。方法入选2016年3月至2019年12月在北部战区总医院接受永久HBP的患者。将入选患者分为3组。Ⅰ组:HBP纠正左束支传导阻滞(LBBB)治疗心力衰竭组;Ⅱ组:持续性高度房室传导阻滞(AVB)或心房颤动(房颤)伴缓慢心室率组;Ⅲ组:间歇性高度AVB组。HBP术中TCP方法:①经股静脉植入临时起搏导线进行临时起搏;②应用待植入其他部位的永久起搏导线临时放置在右心室作为过渡进行临时起搏。结果共入选398例患者,年龄(65±12)岁,年龄范围11~94岁,男227例。其中Ⅰ组64例,Ⅱ组296例,Ⅲ组38例。HBP术中起搏导线找寻HBP位点或导线旋入固定过程中,Ⅰ组43.8%(28/64)的患者发生了高度AVB需要TCP保护完成手术。Ⅱ组43.2%(16/37)的有晕厥史的患者在HBP术中启动了TCP;无晕厥史(0.4%)的患者需要应用TCP比例显著低于有晕厥史(43.2%)的患者(P<0.01)。Ⅲ组中47.4%(18/38)的患者由基础窦性心律或间歇高度AVB转变为高度AVB,需要在TCP保护下完成HBP。结论HBP术中,对于LBBB、间歇性高度AVB及伴晕厥史的高度AVB或房颤伴缓慢心室率患者均应施行保护性TCP。Objective To investigate the indications for temporary cardiac pacing(TCP)during His-bundle pacing(HBP)procedure.Methods Patients who underwent HBP procedure from March 2016 to December 2019 at General Hospital of Northern Theater Command were enrolled.All patients were divided into three groups according to the different indication for permanent cardiac pacing.GroupⅠ:patients had left bundle branch block(LBBB)with heart failure;GroupⅡ:patients had persistent high degree atrioventricular block(AVB)or atrial fibrillation with slow ventricular rate;GroupⅢ:patients had intermittent high degree AVB.TCP was performed by traditional method via femoral vein or by another permanent pacing lead which would be implanted for other purpose during HBP procedure.Results A total of 398 patients with mean age of(65±12)years were enrolled.There were 64 patients in group I,296 patients in GroupⅡand 38 patients in GroupⅢ.High degree AVB during the HBP procedure occurred in 43.8%(28/64)of the patients in groupⅠand TCP was needed in these patients to complete the procedure.In GroupⅡ,TCP was initiated in 43.2%(16/37)of the patients with history of syncope during HBP procedure and the patients without history of syncope who needed TCP was significantly lower than the patients with syncope(0.4%vs 43.2%,P<0.01).In GroupⅢ,47.4%(18/38)of the patients required TCP protection to complete the HBP procedure because lower basic sinus rhythm or intermittent high AVB changed into high AVB during the procedure.Conclusion During HBP procedure,protective TCP should be applied to patients with LBBB or with intermittent high AVB or with history of syncope due to high degree AVB or atrial fibrillation with slow ventricular rate.

关 键 词：左束支传导阻滞 晕厥史 临时心脏起搏 窦性心律 临时起搏 希氏束起搏 起搏导线 AVB 

分 类 号：R541.7[医药卫生—心血管疾病]