左束支起搏患者心脏机械同步性的早期评估  

Assessment of Cardiac Mechanical Synchronization in Patients With Left Bundle Branch Pacing:Results at one Month Post Procedure

作　　者：王淑珍 邓晓奇 熊峰 赵若寒 徐敏 谭焜月 刘春霞 张丽娟 WANG Shuzhen;DENG Xiaoqi;XIONG Feng;ZHAO Ruohan;XU Min;TAN kunyue;LIU Chunxia;ZHANG Lijuan(Department of Cardiology,The Third People’s Hospital of Chengdu,The Affiliated Hospital of Southwest Jiaotong University,The Second Affiliated Chengdu Clinical College of Chongqing Medical University,Chengdu(610031),Sichuan,China)

机构地区：[1]成都市第三人民医院心内科,西南交通大学附属医院,重庆医科大学附属成都市第二临床学院,四川省成都市610031

出　　处：《中国循环杂志》2021年第1期28-33,共6页Chinese Circulation Journal

摘　　要：目的:通过超声心动图评估左束支起搏患者的心脏机械同步性的早期改变。方法:选取2019年5月至2019年12月因二度Ⅱ型及以上房室阻滞在成都市第三人民医院心内科住院并顺利行左束支起搏术(LBBP)的患者21例(LBBP组),同时选取同期行右心室流出道起搏术(RVOTP)的二度Ⅱ型及以上房室阻滞患者23例(RVOTP组)。记录所有患者手术前后心电图QRS波群时限,术中记录起搏参数并于术后1个月行超声心动图检查及随访,观察有无起搏器相关并发症。组织多普勒(TDI)模式获取心房肌运动曲线,通过达峰时间差评估左、右心房内及心房间的同步性(TLI、TIR、TLR);测量二尖瓣前向血流充盈时间(LVFT)与心电图R-R间期的比值(LVFT/RR)用于评估房室间同步性;主、肺动脉射血前时间差作为心室间机械延迟时间(IVMD)用于评估心室间同步性;TDI测量左心室12节段的心肌收缩峰值速度达峰时间的标准差(Tsd-12-LV)代表左心室内同步性;采取盲法原则由两个不同操作者对Tsd-12-LV进行重复性检验。结果:(1)LBBP组IVMD及Tsd-12-LV均明显小于RVOTP组,差异有统计学意义(P<0.05~0.001);而两组间的TLI、TIR、TLR、LVFT/RR差异无统计学意义(P>0.05)。随机选取的16例LBBP者中,Tsd-12-LV的观察者内相关系数(ICC)=0.950,观察者间ICC=0.894。(2)术后超声心动图随访发现两组间常规超声参数差异无统计学意义,未发现电极穿孔、感染、三尖瓣反流加重、心包积液等并发症。(3)LBBP组手术前后QRS波群时限差异无统计学意义,而RVOTP组术后QRS波群时限较术前明显增加,差异具有统计学意义(P<0.001);两组间的术中及术后起搏参数差异无统计学意义(P>0.05)。结论:LBBP是一种新的近生理性起搏方式;二维超声心动图与TDI相结合的方式能简便快速地对患者心房、房室、心室间及心室内的机械活动进行全面定量评估。Objectives:This study aims to evaluate the early alterations of mechanical synchronization post left bundle branch pacing by echocardiography.Methods:21 atrioventricular block patients,who received left bundle branch pacing(LBBP)and 23 atrioventricular block patients,who received right ventricular outflow tract pacing(RVOTP),were included in this study,the electrical parameters were recorded before and during the operation.All patients underwent conventional echocardiography and tissue doppler imaging examination at one month after the implantation.TDI curves of the atrium were obtained to evaluate the inter-atrial and intra-atrial synchronization.The atrio-ventricular synchronization was assessed by the left ventricular filling ratio(LVFT/RR).The interval between the pre-ejection of aortic valve and pulmonary valve(IVMD)referred the interventricular synchronization.TDI was conducted to obtain left-ventricular-12-segement systolic time to peak(Ts).The standard deviation of Ts(Tsd-12-LV)represents the intraventricular synchronization.The Tsd-12-LV was reobtained by two operators in a blinded and random way.Results:Compared with the RVOTP,the interventricular synchronization and intraventricular synchronization were significantly better in LBBP group(P<0.05).Atrial synchronization and atrio-ventricular synchronization were similar between the two groups.The intraobserver and interobserver correlation coefficient was 0.950 and 0.894 respectively.There were no significant complications such as electrode perforation,tricuspid regurgitation and pericardial effusion post implantation.Compared with LBBP,the QRS duration significantly increased after RVOTP(P<0.001).The pacing parameters during and after implantation were similar between the two groups.Conclusions:LBBP is a novel physiological pacing method.The combination of two-dimensional echocardiography and TDI can easily and quickly evaluate atrial,atrioventricular,interventricular and intracardiac mechanical activities.

关 键 词：左束支起搏术 机械同步性 超声心动图 组织多普勒 

分 类 号：R541[医药卫生—心血管疾病]