左束支不同起搏模式对心脏电和机械同步性的影响  

Effect of different pacing modes of left bundle branch on cardiac electrical and mechanical synchrony

作　　者：赵永伟 姜泽宇 邱垣皓 王垚[1] 钱智勇[1] 侯小锋[1] 邹建刚[1] Zhao Yongwei;Jiang Zeyu;Qiu Yuanhao;Wang Yao;Qian Zhiyong;Hou Xiaofeng;Zou Jiangang(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,210029

出　　处：《中华心律失常学杂志》2020年第6期595-599,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的评估左束支起搏(LBBP)不同起搏模式对心脏电和机械同步性的影响。方法选取自2018年2月至2019年5月于南京医科大学第一附属医院心血管内科行LBBP治疗的患者19例,其中男7例(36.8%),年龄(63.6±15.5)岁,分别先后程控单极低电压1 V/0.5 ms(U-LBBP,19例)和双极高电压7.5 V/0.5 ms(B-LBBP,19例)两种起搏模式,分析起搏心电图的形态并测量QRS时限(QRSd)与左心室激动时间(LVAT)评估心脏电同步性;采用核素心肌灌注显像相位分析技术测量两种起搏模式下的相位直方图带宽(PHB)和相位标准差(PSD)评估左心室的机械同步性。选取2014年9月至2016年2月10例行右心室起搏(RVP)的患者作为对照组,其中男7例(70%),年龄(63.8±9.5)岁。比较U-LBBP、B-LBBP和RVP起搏模式的心脏电同步性和左心室的机械同步性。结果行LBBP和RVP治疗的患者基线资料差异无统计学意义。①心脏电同步性比较:U-LBBP时,体表心电图V1导联常呈右束支传导延迟(RBBD)形态,B-LBBP时可纠正RBBD形态;U-LBBP组起搏的QRSd均显著短于RVP组[(117.4±8.6)ms对(147.0±15.7)ms,P<0.001]和B-LBBP组[(111.3±12.7)ms对(147.0±15.7)ms,P<0.001],而B-LBBP组QRSd明显短于U-LBBP组(P=0.013);B-LBBP组LVAT明显短于U-LBBP组[(67.6±12.7)ms对(72.1±10.2)ms,P=0.003]。②左心室机械同步性比较:U-LBBP组的PHB(48.1°±16.7°对60.9°±12.1°,P=0.042)和PSD[(14.9°±5.0°)对(21.0°±3.5°),P=0.002]均小于RVP组,B-LBBP组的PHB(49.8°±13.4°)和PSD(15.9°±4.4°)亦比RVP组小(P=0.037,P=0.004);但U-LBBP组和B-LBBP组相比,PHB和PSD差异均无统计学意义。结论LBBP不论单极还是双极起搏较RVP可获得更好的心脏电同步性和左心室机械同步性;LBBP时,与单极低电压起搏相比,双极高电压起搏可纠正RBBD形态并改善心脏的电同步性,但并不能改善左心室的机械同步性。Objective To evaluate the effect of different pacing modes of left bundle branch pacing(LBBP)on cardiac electrical and mechanical synchrony.Methods From February 2018 to May 2019,19 patients with LBBP were selected from the Department of Cardidogy in The First Affiliated Hospital of Nanjing Medical University,including male 7,with an average age of(63.6±15.5)years.Programmability was performed successively under two pacing modes:unipolar LBBP(U-LBBP group,19 patients)at 1 V/0.5 ms and bipolar LBBP(B-LBBP group,19 patients)at 7.5 V/0.5 ms.The morphology of pacing electrocardiograms was analyzed.The QRS duration(QRSd)and left ventricular activation time(LVAT)were measured to evaluate the cardiac electrical synchrony.The phase histogram bandwidth(PHB)and phase standard deviation(PSD)were measured by the phase analysis technology of gated SPECT myocardial perfusion imaging to evaluate the left ventricular mechanical synchrony.From September 2014 to February 2016,10 patients with right ventricular pacing(RVP)were enrolled as the control group,including male 7,with an average age of(63.8±9.5)years.The cardiac electrical synchrony and left ventricular mechanical synchrony were compared among U-LBBP,B-LBBP and RVP groups.Results The baseline demography was not significantly different between LBBP and RVP patients.Comparison of the cardiac electrical synchrony among three groups:the paced QRS morphology of lead V1 was characterized by right bundle branch conduction delay(RBBD)during unipolar LBBP,while bipolar LBBP could correct the RBBD.The pacing QRSd in U-LBBP group[(117.4±8.6)ms]and in B-LBBP group[(111.3±12.7)ms]were significantly shorter than that in RVP group[(147.0±15.7)ms,P<0.001].The QRSd of B-LBBP group was significantly shorter than that of U-LBBP group(P=0.013).The LVAT of B-LBBP group was significantly shorter than that of U-LBBP group[(67.6±12.7)ms vs.(72.1±10.2)ms,P=0.003].Comparison of the left ventricularmechanical synchrony among three groups,the PHB(48.1°±16.7°vs.60.9°±12.1°,P=0.042)and PS

关 键 词：心脏起搏 人工 左束支起搏 右心室起搏 右束支传导延迟 心室同步性 

分 类 号：R541.7[医药卫生—心血管疾病]