10例老年患者左束支区域起搏临床分析  

Left bundle branch area pacing in 10 elderly patients

作　　者：时向民[1] 李健[1] 李世兴 Shi Xiangmin;Li Jian;Li Shixing(Department of Cardiology,Chinese PLA General Hospital No.1 Medical Center,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心内科,北京100853

出　　处：《中华老年心脑血管病杂志》2020年第11期1165-1169,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的分析10例老年患者左束支区域起搏后的心电图特点及起搏参数,探讨老年人左束支区域起搏的有效性及安全性。方法选择2018年9月~2020年1月解放军总医院第一医学中心心内科行左束支区域起搏患者10例,其中男性4例,女性6例,年龄61~90(74.0±11.2)岁。病态窦房结综合征及Ⅲ度房室传导阻滞各3例,置入双腔起搏器;心房颤动伴缓慢心室率2例,置入心室单腔起搏器;心力衰竭伴左束支传导阻滞2例,1例心脏再同步化治疗(CRT),另1例因原心脏再同步化除颤器无反应及电池耗竭,补救性置入左束支区域起搏电极并更换脉冲发生器。所有患者采用Medtronic 3830起搏电极,经左锁骨下静脉途径及Medtronic C315鞘置入,右心室间隔面拧至左束支区域。结果10例患者左束支区域起搏全部成功,围术期无心包积液及电极脱位等并发症。术后双极起搏QRS波时程与术前比较有缩短趋势,但差异无统计学意义[(121.0±10.4)ms vs(132.2±22.4)ms,P>0.05]。7例V1导联呈qR型,3例呈QS型。7 d后复测起搏参数显示,起搏阈值及R波幅度较置入即刻明显降低[(0.63±0.26)V vs(0.98±0.38)V,(6.25±3.35)mV vs(8.94±3.10)mV,P<0.01],双极阻抗无明显变化[(817±136)Ωvs(794±150)Ω,P>0.05]。结论老年人左束支区域起搏安全、有效,起搏后QRS波缩短,较右心室间隔部及心尖部起搏更为生理,左束支区域起搏可作为CRT无反应的一种补救性措施,联合左心室起搏较传统双室起搏可能更理想。Objective To study the safety and efficacy of left bundle branch area pacing(LBBAP)in 10 elderly patients by analyzing their electrocardiographic characteristics and major LBBAP parameters.Methods Ten patients(4 males and 6 females)aged 61-90(74.0±11.2)years who underwent LBBAP in our center from September 2018 to January 2020 were included in this study.Of them,3 with sick sinus syndrome and 3 with third degree atrioventricular block underwent dual chamber pacemaker implantation,2 with permanent AF and slow ventricular response underwent single ventricular chamber pacemaker implantation,2 with heart failure and left bundle branch block underwent cardiac resynchronization therapy and alternative LBBAP with generator replacement due to non-response to cardiac resynchronization therapy and battery depletion.The Medtronic 3830 pacing electode was implanted into the right ventricular septum and screwed to the left bundle branch area via the left subclavian vein and Medtronic C315 sheath.Results The LBBAP was successful in 10 patients with no pericardial effusion and electrode dislodgement occurred during the periprocedure period.No significant difference was found in QRS width before and after LBBAP(121.0±10.4 ms vs 132.2±22.4 ms,P>0.05).However,the V1 lead showed qR pattern in 7 patients and QS pattern in 3 patients.The pacing parameters showed that the pacing threshold and R wave amplitude were significantly lower after 7 days of LBBAP than during LBBAP(0.63±0.26 V vs 0.98±0.38 V,6.25±3.35 mV vs 8.94±3.10 mV,P<0.01).No significant change was detected in bipolar impedance on day 7 after LBBAP(817±136Ωvs 794±150Ω,P>0.05).Conclusion LBBAP is safe and effective for elderly patients.The QRS is shorter and more physiological after LBBAP than after traditional right ventricular pacing.LBBAP can thus be used as an alternative for heart failure patients who are non-responsive to cardiac resynchronization therapy.The effect of LBBAP is more satisfactory for heart failure patients when LBBAP is combined with left v

关 键 词：心电描记术 心脏起搏器 人工 电极 植入 血流动力学 心力衰竭 

分 类 号：R541.7[医药卫生—心血管疾病]