希浦系统起搏操作和临床分析:单中心经验  

Clinical analysis of his-purkinje system pacing from a single-center pilot study

作　　者：盛琴慧[1] 褚松筠[1] 金汉 陈尔冬[1] 王玉玲[1] 王梓鸣 周菁[1] SHENG Qin-hui;CHU Song-yun;JIN Han;CHEN Er-dong;WANG Yu-ling;WANG Zi-ming;ZHOU Jing(Department of Cardiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科,北京100034

出　　处：《中国介入心脏病学杂志》2021年第4期201-205,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的总结北京大学第一医院前50例希浦系统起搏病例,为初期开展此项技术提供临床借鉴。方法回顾性分析2019年4-12月本中心同一术者团队行希浦系统起搏操作的前50例患者资料及手术和随访情况。按起搏部位分为希氏束起搏(HBP)组、左束支区域起搏(LBBP)组、室间隔内起搏(IVSP)组,比较各组间的手术操作、起搏结果和参数随访情况。结果按患者手术先后顺序每10例患者一组,共分为5组。随着手术例数的增加,希浦系统起搏的成功率从前10例的50%上升至最后10例的90%,而手术时间显著缩短[(152.7±55.1)min比(89.8±37.7)min,P=0.037],完成20例手术后,成功率稳定在80%以上较好的水平。按照最终起搏的结果,IVSP组15例、HBP组10例、LBBP组25例。左心室激动时间(LVAT),HBP组[(79.4±8.2)ms比(96.0±19.2)ms,P=0.012]和LBBP组[(81.5±13.5)ms比(96.0±19.2)ms,P=0.013]均显著短于IVSP组,差异均有统计学意义;而HBP组和LBBP组[(79.4±8.2)ms比(81.5±13.5)ms,P=0.928]比较,差异无统计学意义。起搏QRS波时限,HBP组[(106.4±19.9)ms比(138.8±18.9)ms,P<0.001]和LBBP组[(118.9±12.3)ms比(138.8±18.9)ms,P<0.001]均显著短于IVSP组,差异均有统计学意义;LBBP组较HBP组延长[(118.9±12.3)ms比(106.4±19.9)ms,P=0.030],差异有统计学意义。但HBP组的起搏阈值显著高于IVSP组[(1.4±0.5)V比(0.6±0.3)V,P<0.001]和LBBP组[(1.4±0.5)V比(0.7±0.2)V,P=0.019],差异均有统计学意义。感知R波则HBP组显著低于IVSP组[(5.7±2.1)mV比(10.2±5.3)mV,P=0.009]和LBBP组[(5.7±2.1)mV比(9.6±2.2)mV,P<0.001]。而LBBP组和IVSP组各项起搏参数均无差异。各组随访期间,起搏阈值和感知R波均无明显变化。手术操作中我们采用了影像法辅助希氏束及左束支区域的解剖定位。结论本中心回顾分析显示,第20~50例的手术操作,可以较熟练掌握希浦系统起搏技术。LBBP可作为初期开展希浦系统起搏的首选。影像解剖定位法可简化手术流程,避�Objective To optimize the process of his-purkinje system pacing at the beginning stage based on the first 50 cases experiences from Peking University First Hospital.Methods The demographic,procedure and follow-up data of 50 consecutive cases treated by the same team in our center since April 2019 to December 2019,who underwent his-purkinje system pacing,were retrospectively reviewed and analyzed.Results The overall 50 patients were divided into 5 groups,10 patients in each,according to the procedure sequence.The successful rate of capturing his-purkinje system increased steadily with implanting cases increased,up to 90%in the last 10 patients from the beginning 50%,while the procedure time decreased significantly[(89.8±37.7)min vs.(152.7±55.1)min,P=0.037],and the success rate were stable over 80%after fi rst 20 cases.Based on the fi nal pacing result,there were 15 of IVSP,10 of HBP and 25 of LBBP.There was no signifi cant diff erence in the basic QRS duration(QRSd)between groups,while the pacing QRSd in both LBBP and HBP groups were significantly shorter than IVSP group[(106.4±19.9)ms and(118.9±12.3)ms vs.(138.8±18.9)ms,respectively,P<0.001].And LBBP group had much lower threshold[(0.7±0.2)V vs.(1.4±0.5)V,P=0.019]and better sensitivity[(9.6±2.2)mV vs.(5.7±2.1)mV,P<0.001]compared to HBP group.To make the procedure more eff ective and safer,we used the radiography images instead of his potential to locating pacing sites.Conclusions Through 20-50 cases training,the procedure of hispurkinje system pacing might be relatively skillful.LBBP should be the optional first choice for the beginner due to its better performance than HBP.Radiographic imaging was a useful method to locate the sites for HBP and LBBP.

关 键 词：希浦系统起搏 希氏束起搏 左束支区域起搏 

分 类 号：R541.3[医药卫生—心血管疾病]