左心室射血分数轻度下降的慢性心力衰竭合并左束支传导阻滞患者行左束支起搏的可行性和有效性初步研究  

A preliminary study of left bundle branch pacing in patients with chronic heart failure and left bundle branch block with mildly decreased left ventricular ejection fraction

作　　者：陈学颖 白英楠 王蔚 柏瑾 秦胜梅 汪菁峰 徐磊 张磊 梁义秀 李明辉 潘磊 陈佳慧 李骁 禹子清 宿燕岗 Chen Xueying;Bai Yingnan;Wang Wei;Bai Jin;Qin Shengmei;Wang Jingfeng;Xu Lei;Zhang Lei;Liang Yixiu;Li Minghui;Pan Lei;Chen Jiahui;Li Xiao;Yu Ziqing;Su Yangang(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所国家放射与治疗临床医学研究中心,上海200032

出　　处：《中华心律失常学杂志》2022年第4期339-343,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(82170387);上海申康中心临床研究项目(SHDC2020CR4003);复旦大学附属中山医院临床研究专项基金(2020ZSLC08)。

摘　　要：目的探讨在左心室射血分数轻度下降的慢性心力衰竭(心衰)合并左束支传导阻滞患者中行左束支起搏的可行性和有效性。方法连续入选2019年4月至2021年4月因慢性心衰合并左束支传导阻滞在复旦大学附属中山医院心内科行左束支起搏的患者,进行前瞻性观察性研究。入选标准:①窦性心律、左束支传导阻滞、QRS时限≥150 ms;②经优化药物治疗>3个月后仍有慢性心衰的症状、体征且左心室射血分数(LVEF)在36%~50%;③同意植入双腔起搏器行左束支起搏。随访6个月,比较术前与术后QRS时限、起搏参数、临床心功能、超声心动图参数的变化。结果共入选11例患者,其中男7例(63.63%,7/11),年龄(64.27±12.85)岁。11例患者左束支起搏均成功,成功率100%。QRS时限从术前的(167.09±9.69)ms缩窄为(114.91±15.16)ms,差异有统计学意义(P<0.001)。术中和术后6个月相比,起搏阈值、感知参数均差异无统计学意义(P>0.05),阻抗差异有统计学意义[(699.09±119.70)Ω对(588.82±84.99)Ω,P<0.001];心功能(NYHA分级)显著下降,差异有统计学意义[(2.55±0.52)级对(1.45±0.52)级,P<0.001);N末端脑钠肽前体水平显著下降[(954.27±287.72)pg/ml对(229.10±69.08)pg/ml,P=0.023);左心室射血分数(44.00%±5.33%对54.73%±4.92%,P<0.001)、左心室舒张末期内径[(59.18±6.08)mm对(53.64±5.66)mm,P=0.011]、左心室收缩末期内径[(45.55±6.15)mm对(36.36±5.37)mm,P=0.001]、左心房内径[(46.45±6.47)mm对(43.27±6.42)mm,P=0.002]、二尖瓣反流程度(2.14±0.95对1.45±0.79,P=0.010),差异均有统计学意义。结论对左心室射血分数轻度下降的慢性心衰合并左束支传导阻滞患者,左束支起搏成功率高,术后随访6个月起搏参数稳定,临床心功能显著改善。Objective To study the feasibility and efficacy of left bundle branch pacing(LBBP)in chronic heart failure with mildly reduced left ventricular ejection fraction(LVEF)and left bundle branch block(LBBB).Methods Patients received LBBP implantation from April 2019 to April 2021 were consecutively included for a prospective observational study.Inclusion criteria were①sinus rhythm,LBBB and QRS duration≥150 ms;②symptomatic heart failure with LVEF 36%~50%;③approval of a dual chamber pacemaker implantation.QRS duration,pacing parameters,clinical heart function and echocardiographic parameters were accessed at baseline and during 6-month follow-up.Results Eleven patients were included and received LBBP with success rate of 100%.QRS duration was significantly decreased from(167.09±9.69)ms to(114.91±15.16)ms(P<0.001).The pacing threshold and R wave amplitude were not significantly different as compared to 6-month follow-up.While pacing impedance was significantly decreased[(699.09±119.70)Ωvs.(588.82±84.99)Ω,P<0.001].There was significant difference between pre-procedure and 6-month follow-up in cardiac function(NYHA grade,2.55±0.52 vs.1.45±0.52,P<0.001).N-terminal pro-B-type natriuretic peptide levels[(954.27±287.72)pg/ml vs.(229.10±69.08)pg/ml,P=0.023],LVEF(44.00%±5.33%vs.54.73%±4.92%,P<0.001),left ventricular end-diastolic diameter[(59.18±6.08)mm vs.(53.64±5.66)mm,P=0.011],left ventricular end-systolic diameter[(45.55±6.15)mm vs.(36.36±5.37)mm,P=0.001],left atrial diameter[(46.45±6.47)mm vs.(43.27±6.42)mm,P=0.002]and mitral valve regurgitation(2.14±0.95 vs.1.45±0.79,P=0.010)were all improved.Conclusion The success rate of LBBP in chronic heart failure with mildly reduced LVEF and LBBB was high.The pacing parameters were stable and the clinical heart function were significantly improved during 6-month follow-up.

关 键 词：起搏器 人工 心力衰竭 左心室射血分数 左束支传导阻滞 左束支起搏 

分 类 号：R541.6[医药卫生—心血管疾病]