左束支区域起搏用于心室起搏电极植入治疗心动过缓的临床疗效及安全性  

Clinical efficacy and safety of left bundle branch region pacing for implantation of ventricular pacing electrode in treatment of bradycardia

作　　者：朱路勇 王岳松 董学滨 邵旭武 王学忠 ZHU Luyong;WANG Yuesong;DONG Xuebin;SHAO Xuwu;WANG Xuezhong(Maanshan Clinical College of Anhui Medical University,Maanshan 243000,China)

机构地区：[1]安徽医科大学马鞍山临床学院,安徽马鞍山243000

出　　处：《山东医药》2022年第7期26-30,共5页Shandong Medical Journal

基　　金：马鞍山市科技计划项目资助(YL2019-04)。

摘　　要：目的观察左束支区域起搏(LBBaP)用于心室起搏电极植入治疗心动过缓的临床疗效及安全性。方法选择因心动过缓需起搏治疗的患者111例,依据心室起搏电极植入部位将患者分为右心室心尖部起搏(RVAP)组、右心室间隔部起搏(RVSP)组、LBBaP组,三组临床资料具有可比性,分别于相应部位植入起搏电极。于术中及术后7 d、12个月测三组起搏参数(阈值、感知和阻抗)。分别于术前及术后7 d、12个月行心脏超声检查,测量三组心力衰竭及非心力衰竭患者左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左室射血分数(LVEF);用电化学发光法检测血浆脑钠肽前体(NT-proBNP);进行十二导联心电图检查,记录QRS波时限。统计三组起搏相关并发症、心力衰竭再住院及心源性死亡情况;统计各组的手术时长、射线曝光时长、射线剂量。结果三组间不同时间起搏参数比较差异均无统计学意义(P均>0.05)。与术前比较,术后7 d三组心力衰竭患者血浆NT-proBNP水平下降(P均<0.05),LVEF、LVDs、LVDd比较差异均无统计学意义(P均>0.05)。术后12个月,RVAP组心力衰竭患者LVEF下降,LVDs、LVDd及血浆NT-ProBNP水平升高(P<0.05);RVSP组心力衰竭患者以上指标无明显变化(P均>0.05);LBBaP组心力衰竭患者LVEF升高,LVDs、LVDd及血浆NT-proBNP水平降低(P均<0.05)。三组非心力衰竭患者各时间点上述心功能指标比较差异无统计学意义(P均>0.05)。与术前比较,三组QRS波时限延长(P均<0.05),其中LBBaP组<RVSP组<RVAP组,差异有统计学意义(P<0.05)。LBBaP组因心力衰竭再住院率低于RVAP组(P<0.05);LBBaP组手术时长、射线曝光时长及射线剂量大于其他两组(P均<0.05)。结论LBBaP起搏参数稳定,对心功能及QRS波时限无明显影响,尤其适用于合并心力衰竭的患者,可降低心力衰竭再住院率;但LBBaP手术时间、射线曝光时间长,射线剂量大。Objective To observe the clinical efficacy and safety of left bundle branch area pacing(LBBaP)for implantation of ventricular pacing electrode in the treatment of bradycardia.Methods A total of 111 patients requiring pacing therapy due to bradycardia were selected and were divided into the right ventricular apical pacing(RVAP)group,right ventricular septal pacing(RVSP)group,and LBBaP group according to the site of ventricular pacing electrode implantation.The clinical data of the three groups were comparable,and pacing electrodes were implanted at different sites.Pacing parameters(threshold,R-Wave amplitude and impedance)were measured in the three groups during surgery and at 7 d and 12 months after surgery.Echocardiography was performed before surgery,7 d after surgery,and 12 months after surgery to measure left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),and left ventricular ejection fraction(LVEF)in the three groups of patients with and without heart failure.The plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)was detected by electrochemiluminescence.Twelve electrocardiograms were performed before surgery,7 d after surgery,and 12 months after surgery to record QRS duration. Pacing-related complications,rehospitalization for heart failure and cardiac death were statistically analyzed among the three groups.The opera tion time,X-ray exposure time,and ray dose of patients in the LBBaP,RVAP,and RVSP groups were recorded.Results There was no significant difference in pacing parameters at different times among the three groups(all P>0.05).The plasma NT-proBNP levels decreased in the three groups of patients with heart failure at 7 d after operation compared with those before operation(all P<0.05),and there were no significant differences in LVEF,LVDs,or LVDd(all P>0.05).At 12 months after operation,LVEF decreased,LVDs,LVDd and plasma NT-proBNP levels increased in patients with heart failure in the RVAP group(all P<0.05);the above indicators did not change significa

关 键 词：心动过缓 起搏器植入 心功能 左束支区域起搏 右心室心尖部起搏 右心室间隔部起搏 

分 类 号：R541.7[医药卫生—心血管疾病]