三度房室传导阻滞患者左束支起搏与右心室间隔部起搏的临床对比研究  

Comparison of left bundle branch pacing and right ventricular pacing in patients with third degree atrioventricular block

作　　者：刘燕青 赵青[1] 赵亮[2] 王茂敬[1] 蔡尚郎[1] Liu Yanqing;Zhao Qing;Zhao Liang;Wang Maojing;Cai Shanglang(Department of Cardiology,The Affiliated Hospital of Qingdao University,Qingdao 266071,China;Department of Echocardiography,The Affiliated Hospital of Qingdao University,Qingdao 266071,China)

机构地区：[1]青岛大学附属医院心血管内科,266071 [2]青岛大学附属医院心脏超声科,266071

出　　处：《中华心律失常学杂志》2021年第2期151-155,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的将左束支起搏(LBBP)与右心室间隔部起搏(RVSP)的电-机械同步性及临床预后进行对比,评估三度房室传导阻滞患者行LBBP治疗的可行性及安全性。方法入选青岛大学附属医院心血管内科2019年1月至2020年3月行三度房室传导阻滞并需永久起搏治疗的患者100例,用随机数字表法将患者随机分成LBBP组和RVSP组,分别行相应起搏治疗。随访并比较两组患者的左心室12节段收缩速度峰值时间(Ts)标准差(Tsd-12-LV)、左心室侧壁基底段与右心室游离壁基底段Ts之差(Ts-LV-RV)、左心室充盈时间与RR间期比值(LVFT/RR)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、QRS时限(QRSd)、QTc间期(按心率校正的QT间期)、起搏参数。结果①成功实施LBBP 50例,RVSP 50例,术后随访起搏阈值、感知及阻抗变化均稳定,且组间差异无统计学意义。②与术前相比,LBBP组术后6个月QRSd[(110.00±10.96)ms对(120.22±22.61)ms]、Ts-LV-RV[(33.88±5.50)ms对(38.68±10.33)ms]、LVFT/RR[(42.38%±3.57%)对(54.54%±5.62%)]较术前改善,差异有统计学意义(P<0.05),LVEF、LVEDD、Tsd-12-LV、QTc间期较术前差异无统计学意义(P>0.05);RVSP组术后6个月LVEDD、LVEF、Ts-LV-RV、QTc间期较术前差异无统计学意义(P>0.05),LVFT/RR较术前改善,差异有统计学意义(P<0.01),QRSd、Tsd-12-LV较术前增加,差异有统计学意义(P<0.05)。③所有患者随访期内未出现心肌穿孔、囊袋出血及导线脱位等并发症,无再发心力衰竭、快速性心律失常住院或死亡等相关事件。结论对于三度房室传导阻滞患者,LBBP术中及半年随访起搏参数稳定,且在改善电-机械同步性方面优于RVSP。Objective To compare the electromechanical synchrony and clinical prognosis between left bundle branch pacing(LBBP)and right ventricular septal pacing(RVSP),and evaluate the feasibility and safety of LBBP in patients with third degree atrioventricular block.Methods A total of 100 patients with third degree atrioventricular block requiring permanent pacing treatment from January 2019 to March 2020 in department of cardiology of The Affiliated Hospital of Qingdao University were randomly divided into 2 groups with Random Number Table,and then operating LBBP and RVSP respectively.The left ventricular 12 segment Ts standard deviation(Tsd-12-LV),pacing parameters,QRS duration(QRSd),QTc interval,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular lateral wall basal segment and right ventricular free wall basal systolic velocity peak time(Ts)(Ts-LV-RV),and left ventricular filling time and RR interval ratio(LVFT/RR)were followed up and compared between the two groups.Results Fifty cases of LBBP and 50 cases of RVSP were successfully performed.Pacing threshold,perception and impedance changes were stable after operation,and there was no significant difference between the two groups.six months after procedure,the QRSd[(110.00±10.96)ms vs.(120.22±22.61)ms],Ts-LV-RV[(33.88±5.50)ms vs.(38.68±10.33)ms]and LVFT/RR[(42.38%±3.57%)vs.(54.54%±5.62%)]in LBBP group were improved,compared with the preoperation(P<0.05).The LVEF,LVEDD,Tsd-12-LV and QTc intervals were not significantly different with those before operation(P>0.05).The LVEDD,LVEF,Ts-LV-RV and QTc intervals in the RVSP group were not significantly different from those before operation(P>0.05),while the LVFT/RR was improved 6 months after operation(P<0.01).The QRSd and the Tsd-12-LV of the RVSP group were increased compared with those before operation.No recurrence of heart failure,tachyarrhythmia hospitalization or death and other related events.Conclusion The pacing parameters of left bundle branch pacing during

关 键 词：房室传导阻滞 左束支区域起搏 右心室间隔部起搏 电-机械同步 

分 类 号：R541.7[医药卫生—心血管疾病]