左束支起搏临床应用的可行性与安全性  

Feasibility and safety of left bundle branch pacing in clinical practice

作　　者：张斌[1] 熊恩来[1] 赵永燕[1] 汪杰[1] 苏浩 ZHANG Bin;XIONG En-lai;ZHAO Yong-yan;WANG Jie;SU Hao(Department of Cardiology,Tongling People's Hospital,Tongling 244000,China;Department of Cardiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230000,China)

机构地区：[1]安徽省铜陵市人民医院心血管内科,铜陵市244000 [2]中国科学技术大学附属第一医院心血管内科,安徽省合肥市230000

出　　处：《广西医学》2020年第22期2907-2912,共6页Guangxi Medical Journal

基　　金：安徽省学术和技术带头人及后备人选科研活动经费资助项目(2018H176)。

摘　　要：目的探讨左束支起搏的临床可行性及安全性。方法回顾性分析41例病态窦房结综合征或者房室阻滞患者的临床资料,其中采用左束支起搏23例(左束支起搏组),采用右室间隔部起搏18例(右室间隔部起搏组)。记录两组起搏情况、手术时间和X线曝光时间,比较两组术中及术后3个月的起搏参数(包括起搏阈值、起搏感知、起搏阻抗)和心电图表现,并观察两组患者术中及术后并发症发生情况。结果左束支起搏组起搏成功21例(91.3%),右室间隔部起搏组均起搏成功。左束支起搏组患者的手术时间、X线曝光时间均长于右室间隔部起搏组(均P<0.05)。术中、术后3个月两组患者的起搏感知、起搏阻抗差异均无统计学意义(均P>0.05),而左束支起搏组患者的术中起搏阈值高于右室间隔部起搏组患者(P<0.05),但3个月后两组差异无统计学意义(P>0.05)。起搏后左束支起搏组患者的QRS波宽度低于右室间隔部起搏组,但两种起搏方式起搏后QRS波宽度均高于术前(P<0.05)。左束支起搏组患者的左室达峰时间短于右室间隔部起搏组患者(均P<0.05)。左束支起搏组中1例患者术后24 h内出现左束支电极脱位,再次手术成功重新调整电极,其余患者未见严重并发症。结论左束支起搏成功率较高,短期内起搏参数理想,未引起严重并发症,具有良好的可操作性,在心电同步性方面可能优于右室间隔部起搏,值得推广应用。Objective To investigate the feasibility and safety of left bundle branch pacing(LBBP)in clinical practice.Methods The clinical data of 41 patients with sick sinus syndrome or atrioventricular block were analyzed retrospectively,including 23 cases receiving LBBP(LBBP group)and 18 cases receiving right ventricular septal pacing(RVSP group).Pacing conditions,operation duration and X-ray exposure time of the two groups were recorded.The pacing parameters(including pacing threshold,pacing perception,pacing impedance)and electrocardiographic findings during operation and three months after operation were compared between the two groups;in addition,the incidence of intraoperative and postoperative complications was observed in both groups.Results Totally 21(91.3%)cases achieved successful pacing in the LBBP group,while all cases demonstrated successful pacing in the RVSP group.The LBBP group had longer operation duration and X-ray exposure time than the RVSP group(all P<0.05).There were no statistically significant differences between the two groups in pacing perception or pacing impedance during operation or three months after operation(all P>0.05),the intraoperative pacing threshold of patients in the LBBP group was higher than that in the RVSP group(P<0.05),but pacing threshold three months postoperatively showed no statistically significant difference between the two groups(P>0.05).The LBBP group exhibited narrower QRS complex than the LVSP group after pacing,but for the two pacing approaches QRS complex was wider after pacing than the preoperative(P<0.05).Patients in the LBBP group had shorter left ventricular activation time compared with patients in the RVSP group(all P<0.05).In the LBBP group,one patient developed dislocation of the left bundle branch electrode within 24 hours after operation,then preformed readjustment of the electrode after successful reoperation,and no severe complications occurred in the remaining patients.Conclusion LBBP has a relatively high success rate,exhibits ideal pacing parameters i

关 键 词：左束支起搏 右室间隔部起搏 病态窦房结综合征 房室阻滞 可行性 安全性 

分 类 号：R541.74[医药卫生—心血管疾病]