婴幼儿左束支区域起搏10例探讨  

Effectiveness investigation on left bundle branch area pacing in 10 infants and toddlers

作　　者：李璟昊 李小梅 江河 张仪 李梅婷 周挥茗 Li Jinghao;Li Xiaomei;Jiang He;Zhang Yi;Li Meiting;Zhou Huiming(Department of Pediatric Cardiology,Heart Center,the First Hospital of Tsinghua University,School of Clinical Medicine,Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院心脏中心小儿科清华大学临床医学院,北京100016

出　　处：《中华儿科杂志》2022年第8期810-814,共5页Chinese Journal of Pediatrics

基　　金：伍舜德博士医学科学研究基金(20240000811);首都临床特色应用研究(Z181100001718207);吴阶平医学基金会临床科研专项(320675018502)。

摘　　要：目的:探讨左束支区域起搏应用于婴幼儿的可行性、安全性及有效性。方法:回顾性病例总结。选择2020年9月至2021年9月于清华大学第一附属医院住院的10例心动过缓婴幼儿(年龄≤3岁)为研究对象,均具有心脏永久起搏器植入指征并行左束支区域起搏,记录术中资料(起搏参数、影像及心电图资料),完善心脏超声检查,术后门诊规律随访。术前及术后资料比较采用配对样本t检验。结果:10例患儿(男6例、女4例),年龄(1.6±0.7)岁,体重(10.3±2.5)kg,均成功接受左束支区域起搏治疗。术后心电图QRS波时限为(100±9)ms,心室起搏比例为(97±7)%。术后随访时间为6(6,12)个月。术后1周时,10例患儿左心室舒张末期内径Z值较比术前明显缩小(1.3±0.6比3.6±1.1,t=9.37,P<0.001),随访期间10例患儿心功能均保持良好,末次随访时左心室射血分数为(66±4)%。末次随访时起搏电极阈值较比术中稍有升高但均≤1.0 V,在临床可接受范围[(0.8±0.1)比(0.5±0.1)V,t=-5.27,P=0.001];电极感知及阻抗与术中对比差异均无统计学意义[(16±5)比(14±4)mV,(584±88)比(652±86)Ω,t=-0.83、2.26,P=0.426、0.050]。随访期间未见电极脱位、电极故障等并发症发生。结论:左束支区域起搏可安全有效地应用于婴幼儿,起搏QRS波时限窄且术后心功能保持良好,电极参数稳定。Objective To explore the feasibility,safety and effectiveness of left bundle branch area pacing(LBBAP)in children aged≤3 years.Methods A total of 10 children aged≤3 years who were diagnosed with brady arrhythmia in the First Hospital of Tsinghua University from September 2020 to September 2021 were retrospectively analyzed.All the children met the indication of permanent pacemaker implantation and underwent LBBAP successfully.The intraoperative data(pacing parameters,electrocardiogram and radiographic imaging),cardiac ultrasound data and clinical data during regular postoperative follow-up were recorded.The preoperative and postoperative data were compared using matched samples t test.Results Ten children(aged(1.6±0.7)years with weight of(10.3±2.5)kg)underwent LBBAP successfully.The QRS wave duration on the postoperative electrocardiogram was(100±9)ms,and the percentage of ventricular pacing was(97±7)%.The postoperative follow-up period was 6(6,12)months.At 1 week after operation,the left ventricular end-diastolic diameter Z scores in these children reduced significantly compared with those before operation(1.3±0.6 vs.3.6±1.1,t=9.37,P<0.001).During the follow-up period,cardiac function was normal and the last left ventricular ejection fraction was(66±4)%in all children.At the last follow-up,the pacing threshold of the 10 children was smaller than 1.0 V and was acceptable.Compared with the intraoperative baseline values,the pacing threshold was slightly higher((0.8±0.1)vs.(0.5±0.1)V,t=-5.27,P=0.001).However,no significant difference was found regarding sensing threshold((16±5)vs.(14±4)mV,t=-0.83,P=0.426)and impedance((584±88)vs.(652±86)Ω,t=2.26,P=0.050).During follow-up,no electrode related complications were recorded.Conclusions LBBAP is safe and effective for infants and toddlers.Narrow QRS pacing with stable pacing parameters and normal cardiac function could be achieved postoperatively.

关 键 词：心脏起搏器 人工 儿童 心动过缓 

分 类 号：R726.5[医药卫生—儿科]