左束支起搏治疗心力衰竭的房室间期优化  

Optimal study of atrioventricular interval of left bundle branch pacing in the treatment of heart failure

作　　者：赵晶 赵玲[1] 华宝桐[1] 王钰[1] 赵璐露 王静[1] 马雪娟[1] 丁子容 蒲里津[1] ZHAO Jing;ZHAO Ling;HUA Bao-tong;WANG Yu;ZHAO Lu-lu;WANG Jing;MA Xue-juan;DING Zi-rong;PU Li-jin(Department of Cardiology,First Affiliated Hospital of Kunming Medical University,Kunming 650032.Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院心内科云南省心血管病研究所,云南昆明650032

出　　处：《中国心脏起搏与心电生理杂志》2022年第2期110-115,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金(81960070);云南省科技厅-昆明医科大学联合专项基金重点项目[2019FE001(-164)];云南省高层次卫生计生技术人才培养经费资助。

摘　　要：目的 探讨应用频率适应性房室延迟(RAAVD)算法优化左束支区域起搏房室间期(AVI)治疗慢性心力衰竭(CHF)的可行性及疗效。方法 入选符合心脏再同步化治疗I类适应证患者35例,其中左束支起搏(LBBP)组20例和标准双室起搏(BVP)组15例,LBBP组中真性左束支传导阻滞者(t-LBBB亚组)11例,假性左束支传导阻滞者(f-LBBB亚组)9例,所有患者植入带有RAAVD功能的双腔或三腔起搏器。入组患者术后定期随访,比较两组患者6 min步行试验、心电图QRS波时限、心脏彩色超声心动图评价心脏结构、功能及同步化指标的改善情况。结果 与BVP组比较,LBBP组患者术后QRS波时限更窄[(121.70±10.99)ms vs (134.73±10.78)ms,P<0.05],心室间机械延迟时间缩短[(59.45±11.51)ms vs (70.06±12.83)ms,P<0.05],主动脉瓣前向血流速度时间积分增加[(22.05±2.26)cm vs (20.45±2.11)cm,P<0.05],余指标两组比较差异均无显著性(P>0.05);t-LBBB亚组与f-LBBB亚组比较,各指标差异均无显著性(P>0.05)。结论 应用RAAVD算法优化LBBP的AVI治疗CHF更符合生理性,其疗效不劣于BVP。Objective To explore the feasibility and curative effect of applying frequency adaptive atrioventricular delay(RAAVD) algorithm to optimize the left bundle branch regional pacing atrioventricular interval(AVI) in the treatment of chronic heart failure(CHF). Methods Thirty-five patients with Class I indications for cardiac resynchronization therapy were enrolled, including 20 patients in the left bundle branch pacing(LBBP) group and 15 patients in the standard bi-ventricular pacing(BVP) group, and true left bundle branch block in the LBBP group there were 11 cases of retardation(t-LBBB subgroup) and 9 cases of false left bundle branch block(f-LBBB subgroup). All patients were implanted with dual-chamber or triple-chamber pacemakers with RAAVD function. The enrolled patients were followed up regularly after surgery. The 6-minute walk test, QRS complex, and cardiac structure, function and synchronization index evaluated by Echocardiogram were compared between the two groups. Results Compared with BVP group, the postoperative QRS complex in the LBBP group was narrower [(121.7±10.99) ms vs(134.73±10.78) ms, P<0.05], and the interventricular mechanical delay was shortened [(59.45±11.51) ms vs(70.06±12.83) ms, P<0.05], the aortic valve velocity time integral increased [(22.05±2.26)cm vs(20.45±2.11)cm, P<0.05]. There was no statistically significant difference in the other indicators between the two groups(P>0.05);compared with t-LBBB subgroup and f-LBBB subgroup, there was no statistically significant difference in each index(P>0.05). Conclusion The application of RAAVD algorithm to optimize the LBBP AVI for the treatment of CHF is more physiological, and its efficacy is not inferior to BVP.

关 键 词：心血管病学 心脏再同步化治疗 左束支起搏 单左室起搏 频率适应性房室延迟 

分 类 号：R541.61[医药卫生—心血管疾病] R318.11[医药卫生—内科学]