左束支起搏优化的心室同步治疗初探  

Preliminary experience on left bundle branch pacing-optimized cardiac resynchronization therapy for chronic heart failure

作　　者：袁沃亮[1] 李海英 郑韶欣[1] 麦憬霆[1] 周淑娴[1] 王景峰[1] 陈样新[1] Yuan Woliang;Li Haiying;Zheng Shaoxin;Mai Jingting;Zhou Shuxian;Wang Jingfeng;Chen Yangxin(Department of Cardiology,The Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院心内科,广州510120

出　　处：《中华心律失常学杂志》2022年第4期350-354,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：广州市科技计划项目(201804020053)。

摘　　要：目的探讨左束支起搏对慢性心力衰竭(心衰)合并完全性左束支传导阻滞或起搏依赖患者行心脏再同步治疗(CRT)的可行性及有效性。方法入选中山大学孙逸仙纪念医院心内科2018年5月至2020年5月慢性心衰且有CRT适应证的患者,行左束支起搏及CRT。评估患者临床心功能情况,检测N末端脑钠肽前体(NT-proBNP)、QRS时限、左心室射血分数(LVEF)等指标,并进行起搏器程控优化;对以上结果进行0.5~1.0年随访。结果10例患者均成功施行左束支起搏治疗。患者QRS时限较术前缩短[(119.40±16.89)ms对(164.60±22.96)ms,P<0.0001];经双心室同步起搏后,部分患者QRS时限进一步缩短[(112.60±19.48)ms对(119.40±16.89)ms,P=0.004]。术后随访发现8例患者心功能改善,9例LVEF明显改善,住院率明显降低,左心室内同步性较前改善。结论左束支起搏对慢性心衰合并完全性左束支传导阻滞或起搏依赖的患者具有可行性及有效性,结合双心室起搏,可进一步减小QRS时限,改善电同步性,提高CRT反应率。Objective To evaluate the feasibility and effectiveness of left bundle branch pacing(LBBP)in the treatment of chronic heart failure(CHF)patients with complete left bundle branch block(CLBBB)or pacing dependence.Methods Ten patients with CHF and cardiac resynchronization therapy(CRT)indications from Department of Cardiology in Sun Yat-sen Memoroial Hospital were enrolled from May 2018 to May 2020,and then were performed LBBP and CRT therapy.We evaluated clinical cardiac function,detected N-terminal pro-brain natriuretic peptide(NT-proBNP),QRS duration(QRSd),left ventricular ejection fraction(LVEF)and other indicators of patients.Pacemakers were programmed to best optimization.These results were followed up for six months to a year.Results LBBP was successfully carried out in all 10 patients.Postoperative electrocardiography suggested that QRSd was shorter than that before surgery[(119.40±16.89)ms vs.(164.60±22.96)ms,P<0.0001].QRSd of some patients was further reduced after biventricular synchronous pacing[(112.60±19.48)ms vs.(119.40±16.89)ms,P=0.004].Postoperative follow up showed that the NYHA cardiac function grade of 8 patients was elevated.LVEF of 9 patients was significantly improved,hospitalization rate was significantly reduced,and left ventricular synchronization was improved.Conclusion LBBP is feasible and effective in the treatment of CHF patients with CLBBB or pacing dependence.Combined with biventricular pacing,QRSd can be reduced further,and so electrical synchronization and CRT response rate can be improved.

关 键 词：心力衰竭 心脏再同步治疗 左束支起搏 完全性左束支传导阻滞 

分 类 号：R541.6[医药卫生—心血管疾病]