比较常规右心室起搏与左束支起搏对三尖瓣反流的影响  

Comparison of the influence of conventional right ventricular pacing and left bundle branch pacing on tricuspid regurgitation

作　　者：林锦璇[1] 周昱安 陈柯萍[1] 戴研[1] 胡清韵 卢文钊 李瑶[1] 李玉秋 徐楠[3] 张澍[1] Lin Jinxuan;Zhou Yu′an;Chen Keping;Dai Yan;Hu Qingyun;Lu Wenzhao;Li Yao;Li Yuqiu;Xu Nan;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;Department of Cardiology,Teda International Cardiovascular Hospital,Tianjin 300457,China;Department of Echocardiography,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 [2]泰达国际心血管病医院心内科,天津300457 [3]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,阜外医院超声影像中心,100037

出　　处：《中华心律失常学杂志》2021年第5期391-396,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81870260)。

摘　　要：目的探索常规右心室起搏(RVP)和左束支起搏(LBBP)对三尖瓣反流(TR)影响的差异。方法本研究为回顾性研究,入选2015年1月至2019年12月在中国医学科学院阜外医院心律失常中心因心动过缓行首次起搏器植入且术前2周内和术后1年以上超声心动图资料齐全的患者,根据心室导线植入位置分为RVP组和LBBP组。分析并比较两组患者术后导线相关TR(LRTR)的发生情况。结果140例患者纳入研究,年龄(65.0±11.3)岁,男58例(58/140,41.4%),RVP组73例(73/140,52.1%),LBBP组67例(67/140,47.9%)。两组术后新发TR的发生率分别为13.7%(10/73)和7.5%(5/67)(P=0.282),TR加重的发生率分别为16.4%(12/73)和13.4%(9/67)(P=0.644)。多因素Logistic回归分析校正基线特征和基线超声心动图参数后,两组术后随访新发TR(校正OR=7.26,95%CI 0.99~53.42,P=0.052)和TR加重(校正OR=3.40,95%CI 0.70~16.45,P=0.128)的发生风险均差异无统计学意义。植入器械时长(校正OR=1.11,95%CI 1.01~1.22,P=0.042)、基线二尖瓣轻度以上反流(校正OR=4.64,95%CI 1.01~21.43,P=0.049)为TR加重的独立危险因素。结论RVP和LBBP术后新发TR或TR加重的发生风险相当,LBBP并不额外增加术后TR加重的发生风险。随访时长和基线合并二尖瓣反流为TR加重的独立预测因素。Objective To investigate the difference of influence of right ventricular pacing(RVP)and left bundle branch pacing(LBBP)on tricuspid regurgitation(TR).Methods Patients who received de novo pacemaker from January 2015 to December 2019 in the Center of Arrhythmia,Fuwai Hospital,and had echocardiograms both 2 weeks prior to and up to 1 year after device placement were retrospectively analyzed.The patients were divided into RVP group and LBBP group according to location of the ventricular lead.The incidence of lead-related TR(LRTR)was analyzed,and compared between the two groups.Results Of the 140 enrolled patients[age(65.0±11.3)years,41.1%(58/140)male],73(73/140,52.1%)patients were in the RVP group,and 67(67/140,47.9%)patients were in the LBBP group.The incidence of new-onset TR after operation in the two groups was 13.7%(10/73)and 7.5%(5/67)(P=0.282),and the incidence of progressive TR was 16.4%(12/73)and 13.4%(9/67)(P=0.644)in RVP and LBBP groups,respectively.After adjusting baseline characteristics using multivariate Logistic regression,the risk of new-onset TR(adjusted OR=7.26,95%CI 0.99-53.42,P=0.052)and progression of TR(adjusted OR=3.40,95%CI 0.70-16.45,P=0.128)after pacemaker implantation in the RVP group and the LBBP group showed no significant difference.Device implantation time(adjusted OR=1.11,95%CI 1.01-1.22,P=0.042)and baseline mitral regurgitation(adjusted OR=4.64,95%CI 1.01-21.43,P=0.049)were independent risk factors of progressive TR.Conclusion The risk of new-onset TR or progressive TR after LBBP is similar to that of RVP,and LBBP does not increase the risk of TR.Device implantation time and baseline mitral regurgitation were independent predictors of TR.

关 键 词：心脏起搏器 人工 三尖瓣反流 左束支起搏 右心室起搏 

分 类 号：R541.7[医药卫生—心血管疾病]