左束支起搏在房室传导阻滞伴射血分数降低患者中的初步应用  

Application of left bundle branch pacing in patients with atrioventricular block and reduced left ventricular ejection fraction

作　　者：吴圣杰[1] 王松洁 尚文轩 王良国[1] 连莉优 何燕磊 徐蕾[1] 苏蓝[1] 黄伟剑[1] Wu Shengjie;Wang Songjie;Shang Wenxuan;Wang Liangguo;Lian Liyou;He Yanlei;Xu Lei;Su Lan;Huang Weijian(Department of Cardiology,The First Affiliated Hospital of Wenzhou Medical University,The Key Lab of Cardiovascular Disease of Wenzhou,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院心内科温州市心血管病重点实验室,温州325000

出　　处：《中华心律失常学杂志》2022年第4期344-349,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：浙江省重点研发项目(2019C03012)。

摘　　要：目的比较左束支起搏(LBBP)与右心室起搏(RVP)在房室传导阻滞伴射血分数降低患者的起搏参数、安全性及心脏结构与功能改善。方法收集2018年3月至2021年3月期间在温州医科大学附属第一医院心内科诊断为房室传导阻滞伴左心室射血分数(LVEF)降低(<50%),且初次尝试LBBP或原RVP升级LBBP患者;回顾入选我院同时期具有相同入排标准及植入适应证且初次行RVP植入患者。比较两组基线及随访1年时起搏阈值、感知、QRS时限变化、LVEF、左心室舒张末期内径(LVEDD)。结果共入选62例患者,其中LBBP组34例,年龄(69.1±16.5)岁,其中男25例;RVP组28例,年龄(70.3±16.1)岁,其中男21例。LBBP组自身及起搏QRS时限分别为(132.1±35.6)ms和(109±21.5)ms,左束支夺获阈值(0.61±0.37)V/0.5 ms,感知(9.2±6.4)mV;RVP组自身及起搏QRS时限分别为(136.3±26.6)ms,(167.9±21.1)ms,阈值(0.73±0.34)V/0.5 ms,感知(10.4±2.8)mV。LBBP组随访1年时,LVEF增幅为8.3%,LVEDD减少幅度为3.9 mm;RVP组平均LVEF增幅为2.8%(P=0.024),但LVEDD反而增大1.9 mm。LBBP组LVEF增高≥10%比例高于RVP组(41.2%对25.0%,P=0.180),未见LVEF下降超过10%患者,而RVP组中17.9%(5/28)的患者LVEF下降超过10%。结论在房室传导阻滞伴LVEF下降患者,LBBP阈值低、感知良好,参数与RVP相似,有明显的心功能及心室重构获益。Objective To compare the pacing parameters and cardiac performance between left bundle branch pacing(LBBP)and right ventricular pacing(RVP)in patients with atrioventricular block(AVB)and reduced left ventricular ejection fraction(LVEF).Methods Patients with AVB and LVEF<50%from March 2018 to March 2021 who attempted LBBP(primary or upgraded from RVP)or RVP in Department of Cardiology,The First Affiliated Hospital of Wenzhou Medical University were enrolled.The capture threshold,R-wave amplitude,QRS duration,LVEF and left ventricular end-diastolic diameter(LVEDD)were compared between the two groups at baseline and 1-year follow-up.Results A total of 62 patients were enrolled,including 34 in the LBBP group[(69.1±16.5)years old,male 25]and 28 in the RVP group[(70.3±16.1)years old,male 21].The intrinsic QRS duration,paced QRS duration,LBB capture threshold,R-wave amplitudes in LBBP group were(132.1±35.6)ms,(109±21.5)ms,(0.61±0.37)V/0.5 ms,(9.2±6.4)mV,respectively.While,in RVP group,the intrinsic and paced QRS duration were(136.3±26.6)ms and(167.9±21.1)ms,with myocardium threshold of(0.73±0.34)V/0.5 ms and amplitude of(10.4±2.8)mV.During 1-year follow-up,8.3%improvement in LVEF and 3.9 mm decreasement in LVEDD were observed in LBBP group.In RVP group,the mean LVEF increased by 2.8%(P=0.024),but the LVEDD increased by 1.9 mm.The LBBP group showed a higher proportion of increased LVEF by≥10%than that in the RVP group(41.2%vs.25.0%P=0.180).None had a LVEF decrease of>10%in LBBP group,while 17.9%(5/28)had a LVEF decrease of>10%in the RVP group.Conclusion In patients with AVB and decreased LVEF,LBBP had a low threshold,optimal amplitude which is similar to right ventricular pacing but showed better improvements in cardiac function and ventricular remodeling.

关 键 词：心力衰竭 左束支起搏 右心室起搏 房室传导阻滞 同步化治疗 

分 类 号：R541.7[医药卫生—心血管疾病]