左束支区域起搏对慢性心力衰竭患者微伏级T波电交替的影响  

Effect of Left Bundle Branch Area Pacing on Microvolt T-Wave Alternans in Patients with Chronic Heart Failure

作　　者：孔丽娟 郑晓琳 卢文杰[1] 王玺[1] 邱春光[1] KONG Lijuan;ZHENG Xiaolin;LU Wenjie;WANG Xi;QIU Chunguang(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心内科,河南郑州450052

出　　处：《河南医学研究》2022年第17期3078-3081,共4页Henan Medical Research

摘　　要：目的探讨以左束支区域起搏(LBBAP)模式完成的心脏再同步化治疗(CRT)对慢性心力衰竭患者微伏级T波电交替(MTWA)的影响。方法选取2019年12月至2021年12月于郑州大学第一附属医院心内科接受LBBAP-CRT的31例慢性心力衰竭患者作为研究对象。术后1周及术后3个月,采用时域法分别在心房抑制型起搏(AAI)和LBBAP模式下测试不同起搏频率(90、110次·min^(-1))时的MTWA振幅,对比不同起搏模式、起搏频率以及术后不同时间节点的MTWA振幅。结果术后1周和术后3个月,起搏频率为90和110次·min^(-1)时,LBBAP模式下的MTWA振幅均小于AAI模式(P<0.05);术后3个月,LBBAP模式下的MTWA振幅小于术后1周(P<0.05)。术后3个月患者的左室舒张末期内径(LVEDD)小于术前,左室射血分数(LVEF)高于术前,差异有统计学意义(P<0.05)。术后QRS时限[(123.71±9.55)ms]短于术前[(158.58±13.22)ms],差异有统计学意义(P<0.05)。结论相较于自身下传节律(AAI模式),LBBAP可减小慢性心力衰竭患者的MTWA振幅,改善慢性心力衰竭患者的心功能,且随着治疗时间的延长,其对MTWA的改善作用进一步累积。Objective To investigate the effect of cardiac resynchronization therapy(CRT)completed in left bundle branch area pacing(LBBAP)mode on microvolt T-wave alternans(MTWA)in patients with chronic heart failure.Methods A total of 31 patients with chronic heart failure who received LBPAP-CRT in the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from December 2019 to December 2021 were selected as the research objects.One week and three months after operation,the MTWA magnitude at different pacing frequencies(90,110 beats·min^(-1))were measured by time domain method in atrial inhibited pacing(AAI)mode and LBBAP mode,respectively,and the MTWA magnitude at different pacing modes,pacing frequencies and different time nodes after operation were compared.Results The MTWA magnitude under LBBAP was smaller than that under AAI mode at pacing rates of 90 and 110 beats·min^(-1) at 1 week and 3 months after operation(P<0.05).The MTWA magnitude under LBBAP was smaller at 1 week after operation than that 3 months after operation(P<0.05).Three months after operation,the left ventricular end-diastolic diameter(LVEDD)was smaller than that before operation,and the left ventricular ejection fraction(LVEF)was higher than that before operation,the differences were statistically significant(P<0.05).The QRS duration after operation[(123.71±9.55)ms]was shorter than that before operation[(158.58±13.22)ms],and the difference was statistically significant(P<0.05).Conclusion Compared with AAI mode pacing,LBBAP can reduce the MTWA magnitude of patients with chronic heart failure.And with the prolongation of treatment time,the improving effect of LBBAP on MTWA can be further accumulated.

关 键 词：慢性心力衰竭 左束支区域起搏 心脏再同步化治疗 微伏级T波电交替 生理性起搏 

分 类 号：R541.6[医药卫生—心血管疾病]