三尖瓣环显像技术指导下的远端希氏束起搏  

Permanent ventricular-side His bundle pacing achieved by the approach of radiographic landmarks in bradycardia patients

作　　者：顾敏[1] 华伟[1] 刘曦[1] 牛红霞[1] 陈旭华[1] 张澍[1] Gu Min;Hua Wei;Liu Xi;Niu Hongxia;Chen Xuhua;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,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,心血管疾病国家重点实验室,阜外医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2021年第5期379-384,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：中央高校基本科研业务费专项资金(3332019047)。

摘　　要：目的探索三尖瓣环显像技术指导下的远端希氏束起搏的可行性。方法入选中国医学科学院阜外医院2019年8月至12月共30例有起搏适应证的心动过缓患者,年龄(64±15)岁,其中男15例(50%,15/30)行远端希氏束起搏。使用希氏束鞘管在三尖瓣隔叶下方造影显示三尖瓣环,并以此为影像学标志,将起搏导线植入三尖瓣下方心室侧希氏束区域(即远端希氏束区域)。评价手术成功率,术中及随访期间希氏束起搏参数、起搏特点、导线对三尖瓣功能的影响以及手术相关的并发症等。结果共28例(93.3%,28/30)患者成功完成远端希氏束起搏。术中希氏束起搏阈值为0.4~1.9(1.00±0.42)V/1 ms,R波振幅为(5.4±2.7)mV。成功完成希氏束起搏的病例中,92.9%(26/28)的患者为非选择性希氏束起搏,夺获希氏束和周围心室肌的阈值分别为(1.03±0.43)V/1 ms和(1.05±0.73)V/1 ms。另外2例选择性希氏束起搏患者的希氏束夺获阈值均为0.7 V/1 ms。随访(19.5±3.5)个月,患者希氏束起搏阈值[(0.97±0.41)V/1 ms对(1.00±0.42)V/1 ms,P=0.643]和R波振幅稳定。未发现手术相关的并发症以及三尖瓣反流加重情况。结论三尖瓣环显像技术指导下的远端希氏束起搏具有较高的手术成功率。远端希氏束起搏多数为非选择性希氏束起搏,随访期间起搏参数稳定。三尖瓣显像技术可帮助定位远端希氏束,完成目的性心室侧希氏束起搏导线植入。Objective This study was to investigate the feasibility of permanent ventricular-side His bundle pacing(vHBP)implantation guided by the radiographic marker of the tricuspid valve annulus(TVA).Methods Permanent vHBP was attempted in 30 patients[50%men,age(64±15)years]with symptomatic bradycardia and indicated for pacemaker implantation in Fuwai Hospital from August 2019 to December 2019.The TVA revealed by right ventriculography was used as an anatomic landmark for localizing the site for vHBP under the TVA.Procedural feasibility,vHBP pacing parameters,the effect of vHBP lead on tricuspid valve function,and procedure-related complications were evaluated.Results Permanent vHBP was successfully achieved under the TVA in 28 of 30 patients(93.3%).The vHBP threshold was(1.00±0.42)V/1 ms(range:0.4-1.9 V/1 ms)and R wave amplitude was(5.4±2.7)mV.Permanent nonselective vHBP was implemented in 92.9%(26/28)of patients,in which the capture threshold for His bundle and local myocardial tissue were(1.03±0.43)V/1 ms and(1.05±0.73)V/1 ms,respectively.Two patients had selective vHBP,each with capture threshold 0.7 V/1 ms.The HBP pacing threshold[(0.97±0.41)V/1 ms vs.(1.00±0.42)V/1 ms,P=0.643]and R wave amplitude remained uncharged during a mean follow-up period of(19.5±3.5)months.There were no procedure-related complications or worsening tricuspid regurgitation during(19.5±3.5)months follow-up.Conclusion Permanent vHBP,mostly nonselective,with a high success rate and and a low and stable pacing threshold in bradycardia patients.Location of the TVA revealed by right ventriculography can be used as a landmark to identify the site of vHBP,making implantation outcome almost predictable.

关 键 词：心脏起搏 人工 远端希氏束起搏 非选择性希氏束起搏 三尖瓣隔叶 造影 放射影像 

分 类 号：R541.7[医药卫生—心血管疾病]