经导管主动脉瓣植入术后左束支起搏的临床应用初探  

Initial clinical experience of left bundle branch pacing after transcatheter aortic valve implantation

作　　者：冯天捷[1] 宋光远[2] 赵杰[2] 陈阳[2] 牛冠男[2] 周政 赵振燕[2] 王墨扬[2] 随永刚[2] 陈柯萍[1] 华伟[1] 吴永健[2] Feng Tianjie;Song Guangyuan;Zhao Jie;Chen Yang;Niu Guannan;Zhou Zheng;Zhao Zhenyan;Wang Moyang;Sui Yonggang;Chen Keping;Hua Wei;Wu Yongjian(Cardiac Arrhythmia Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Coronary Heart Disease Center,Fuwai Hospital,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,阜外医院心律失常中心,北京100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病中心,北京100037

出　　处：《中华心血管病杂志》2022年第2期142-149,共8页Chinese Journal of Cardiology

摘　　要：目的探讨左束支区域起搏(LBBP)运用于经导管主动脉瓣植入术(TAVI)后患者的可行性和安全性。方法本研究为回顾性研究。连续入选2018年1月至2020年12月在中国医学院科学院阜外医院接受TAVI治疗、术后置入永久起搏器的患者35例。根据心室电极放置位置,分为LBBP组(12例)和右心室心尖部起搏(RVAP)组(23例)。计算LBBP组患者的手术成功率,观察其手术相关并发症发生情况,并于术后第3天及1、3、6个月测量起搏器程控参数。比较两组患者TAVI术后1、3、6个月时的N末端B型利钠肽原(NT-proBNP)及超声心动图、心电图指标。结果共纳入35例患者,年龄(76.4±7.7)岁,男性19例(54.3%)。与RVAP组患者比较,LBBP组患者在起搏器置入术中的手术时间[(86.58±17.10)min比(68.74±9.18)min,P<0.001]及X线透视时间[(20.08±4.44)min比(17.00±2.26)min,P<0.001]更长。LBBP组患者的手术成功率为11/12,12例患者均无气胸和血胸、电极脱位、感染以及囊袋出血等严重手术相关并发症发生,随访期间起搏器程控参数均在理想范围且稳定。共随访7.43(5.21,9.84)个月,术后3、6个月时,与RVAP组患者比较,LBBP组患者的左心室射血分数值均更高[3个月时:(60.75±2.89)%比(57.35±3.33)%,P=0.004;6个月时:(63.17±3.33)%比(56.17±3.97)%,P<0.001],NT-proBNP值均更低[3个月:822(607,1150)ng/L比1052(902,1536)ng/L,P=0.006;6个月:440(330,679)ng/L比783(588,1023)ng/L,P=0.001];术后1、3、6个月时,LBBP组患者的QRS时限均较RVAP组患者短[1个月时:99(97,107)ms比126(124,130)ms,P<0.001;3个月时:98(96,105)ms比129(128,133)ms,P<0.001;6个月时:96(94,104)ms比130(128,132)ms,P<0.001]。结论对于TAVI术后存在永久起搏器适应证的患者,LBBP是可行、安全可靠的,短期可改善患者的心功能状态,但远期效果尚待进一步观察。Objective To investigate the efficacy and safety of left bundle branch pacing(LBBP)in patients after transcatheter aortic valve implantation(TAVI).Methods This is a retrospective study.A total of 35 patients underwent TAVI and received pacemaker implantation from January 2018 to December 2020 in Beijing Fuwai Hospital were enrolled.Patients were divided into LBBP group(n=12)and right ventricular apex pacing(RVAP)group(n=23)according to the pacing position.The success rate of operation in LBBP group was calculated,and the occurrence of complications were observed,and the parameters of pacemaker were measured on the 3rd day and 1,3 and 6 months after operation.The N-terminal pro-B-type natriuretic peptide(NT-proBNP),echocardiographic and ECG indexes were compared between the two groups on the 3rd day and 1,3,and 6 months after pacemaker implantation.Result A total of 35 patients were included,The age was(76.4±7.7)years,including 19 males(54.3%).The procedure time((86.58±17.10)min vs.(68.74±9.18)min,P<0.001)and fluoroscopy duration((20.08±4.44)min vs.(17.00±2.26)min,P<0.001)were significantly longer in LBBP group compared with RVAP group.The operation success rate of LBBP group was 11/12.There was no serious operation related complications such as pneumothorax,hemothorax,electrode dislocation,infection,and lower limb bleeding.The patients were followed up for 7.43(5.21,9.84)months.The programmed parameters of pacemaker were in the ideal range and stable during follow-up.At 3 and 6 months after operation,the left ventricular ejection fraction in LBBP group was higher than that in RVAP Group(at 3 months:(60.75±2.89)%vs.(57.35±3.33)%,P=0.004;at 6 months:(63.17±3.33)%vs.(56.17±3.97)%,P<0.001),NT-proBNP values was lower in LBBP group than that in RVAP Group(at 3 months:822(607,1150)ng/L vs.1052(902,1536)ng/L,P=0.006;at 6 months:440(330,679)ng/L vs.783(588,1023)ng/L,P=0.001).At 1,3 and 6 months after operation,the QRS duration was shorter in LBBP group than that in RVAP group(1 month:99(97,107)ms vs.126(124,130)m

关 键 词：心脏瓣膜疾病 左束支起搏 经导管主动脉瓣植入术 起搏器 

分 类 号：R541.7[医药卫生—心血管疾病]