第98课 希氏束起搏植入时的心电图分析(第一部分)  

Lesson Ninety-eight Electrocardiographic analysis for His bundle pacing at implantation(part one)

作　　者：童鸿[1] 

机构地区：[1]浙江省立同德医院心血管科

出　　处：《心电与循环》2020年第6期631-635,共5页Journal of Electrocardiology and Circulation

摘　　要：希氏束夺获的类型希氏束起搏(His bundle pacing,HBP)植入时,如只记录肢体导联心电图,阈值测试过程的QRS形态变化将会细微或缺失,因此,必须记录12导联心电图。希氏束电极不但夺获希氏束,也夺获心室和(或)心房组织,从而影响心电图图形。夺获类型决定于希氏束电极的位置(图1)、希氏束的解剖变异、夺获阈值、起搏输出和起搏配置(如在扩大双极起搏下的阳极夺获)。另外,在束支传导阻滞(bundle branch block,BBB)情况下,HBP可以部分或完全纠正传导异常,这会增加QRS形态的变化。正确识别下述本质实为重要。Types of His capture It is mandatory to record a 12-lead ECG at His bundle pacing(HBP)implantation because changes in QRS morphology during threshold tests may be subtle and missed if only limb leads are used.In addition to capture of the HB,the His lead can capture ventricular and/or atrial tissue that can affect ECG findings.Type of capture depends on His lead position(Figure 1),the anatomical variant of the HB,capture thresholds,pacing output,and pacing configuration(e.g.,anodal capture in case of extended bipolar pacing).Furthermore,in case of underlying BBB,HBP may correct the conduction disease either partially or totally,leading to additional variations in QRS morphology.It is important to correctly identify the following entities.

关 键 词：IMPLANTATION BUNDLE FIGURE 

分 类 号：R540.41[医药卫生—心血管疾病]