左束支区域起搏可改善右束支阻滞的心电图表现  

Impact of Left Bundle Branch Area Pacing on Clinical and Electrocardiogram Characteristics Among Bradycardia Patients With Right Bundle Branch Block

作　　者：王钊[1] 李晓飞[1] 朱浩杰 樊晓寒[1] WANG Zhao;LI Xiaofei;ZHU Haojie;FAN Xiaohan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院,心律失常中心,北京市100037

出　　处：《中国循环杂志》2021年第1期22-27,共6页Chinese Circulation Journal

基　　金：国家自然科学基金面上项目(81970284)。

摘　　要：目的:旨在观察左束支区域起搏(LBBAP)纠正右束支阻滞(RBBB)的临床效果及心电图特点。方法:本研究为单中心、前瞻性观察性研究,纳入2018年4月至2019年12月间入院有心室起搏指征,存在基线RBBB图形且QRS波群时限≥120 ms、左心室射血分数>50%并接受LBBAP的患者,分析LBBAP纠正RBBB的临床效果及心电图特点。结果:共纳入33例患者,平均年龄(63.6±10.5)岁。LBBAP成功者共30例(90.9%),其余3例患者为左心室间隔部起搏。通过调整起搏极性与输出电压,多数患者QRS波群时限较治疗前得以缩窄[(118.2±10.3)ms vs.(142.9±12.1)ms,P<0.001],其中20例(60.6%)实现RBBB完全纠正(QRS波群时限<120 ms),11例(33.3%)实现RBBB部分纠正(QRS波群时限较基线缩窄,但QRS波群时限≥120 ms)。根据V1导联的QRS波群形态,可将RBBB纠正后的心电图图形大致分为4种类型,包括Qr型、QR型、qR型与QS型,其中以Qr型最为常见(n=15,48.4%)。而基线呈现qR型的RBBB患者LBBAP纠正成功率更高(n=5,62.5%)。结论:LBBAP可有效纠正RBBB,显著缩短QRS波群时限,心电图V1导联QRS波群图形以Qr型最为多见,术前V1导联呈现qR型的RBBB患者LBBAP纠正成功率更高。Objectives:Left bundle branch area pacing(LBBAP)has emerged as a feasible physiological pacing form for correction of left bundle branch block(LBBB).Few data are available on effect of LBBAP on clinical and electrocardiogram characteristics in patients with RBBB.Methods:This is a single center,prospective observational study.Consecutive patients with RBBB pattern and QRS duration(QRSd)≥120 ms were enrolled if they underwent LBBAP from April 2018 to December 2019 and left ventricular ejection fraction(LVEF)was>50%.Clinical characteristics,implant pacing parameters,and electrocardiographic morphologies at baseline and after LBBAP were assessed.Results:A total of 33 patients were included,the mean age was(63.6±10.5)years old and average QRSd was(142.9±12.1)ms.LBBAP was successful in 30 patients(90.9%)with significant narrowing of QRSd from(142.9±12.1)ms to(118.2±10.3)ms(P<0.001).The RBBB was completely corrected in 60.6%patients(20/33)with post-LBBAP QRSd<120 ms and partially corrected in 33.3%patients(11/33)with post-LBBAP QRSd≥120 ms.Four forms of QRS morphologies in lead V1 were observed after LBBAP,including Qr(48.4%),QR(22.6%),qR(19.4%)and QS(9.7%)patterns.Complete RBBB correction was more likely to be achieved by LBBAP in patients with QRS morphology of qR pattern at baseline.Conclusions:LBBAP could effectively correct RBBB and narrow QRSd in patients with RBBB.LBBAP could effectivly correct RBBB,complete RBBB correction was more likely to be achieved by LBBAP in patients with QRS morphology of qR pattern at baseline.

关 键 词：左束支区域起搏 右束支阻滞 心电图形态 起搏 

分 类 号：R541[医药卫生—心血管疾病]