LBBP CRT对心力衰竭伴希氏束起搏不能纠正的完全性左束支传导阻滞患者的疗效研究  

Effect of left bundle branch pacing for cardiac resynchronization therapy on heart failure patients with His bundle pacing uncorrected complete left bundle branch block

作　　者：程颖[1] 杨性安[2] 卢先本[1] CHENG Ying;YANG Xing'an;LU Xianben(Department of Cardiology,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China)

机构地区：[1]浙江省台州医院心内科,317000 [2]浙江省台州医院超声科,317000

出　　处：《心电与循环》2022年第5期425-430,435,共7页Journal of Electrocardiology and Circulation

基　　金：浙江省医药卫生科技计划项目(2019KY775);台州市科技计划项目(21ywa16)。

摘　　要：目的评估左束支起搏心脏再同步化治疗(LBBP CRT)对心力衰竭(下称心衰)伴希氏束起搏(HBP)不能纠正的完全性左束支传导阻滞(CLBBB)患者的疗效。方法选择2020年1月至11月浙江省台州医院行LBBP CRT的心衰伴HBP不能纠正的CLBBB患者6例。采集12导联心电图评估术前术后电同步性,采用超声心动图评估起搏时及停止起搏10 min后机械同步性[左心室12节段心肌收缩峰值速度时间标准差(Tsd-12-LV)、心室间机械延迟(IVMD)],比较术前及术后6个月纽约心脏病协会(NYHA)心功能分级及超声心动图指标。结果6例患者术后QRS时间(124.5±5.7)ms,与术前QRS时间(162.8±17.0)ms比较,差异有统计学意义(P<0.05)。起搏时Tsd-12-LV为(41.5±7.6)ms,IVMD为(19.5±5.9)ms,与停止起搏10 min后[(58.7±15.8)ms,(50.0±9.3)ms]比较,差异均有统计学意义(均P<0.05)。术后6个月,NYHA心功能分级较术前改善(P<0.05)。结论LBBP CRT对心衰伴HBP不能纠正的CLBBB患者有一定疗效。Objective To evaluate the effect of left bundle branch pacing(LBBP)for cardiac resynchronization therapy(CRT)on heart failure patients with His bundle pacing(HBP)uncorrected complete left bundle branch block(CLBBB).Methods A total of 6 heart failure patients underwent LBBP-CRT after HBP failed to correct CLBBB in Taizhou Hospital of Zhejiang Province from January to November 2020 were selected.Electrical synchrony was measured on 12-lead electrocardiogram before and after the operation.Mechanical synchrony was evaluated by Doppler echocardiography during LBBP and 10 minutes after stopping LBBP.The NYHA class and echocardiographic parameters before and 6 months after the operation were compared.Results The postoperative QRS duration was(124.5±5.7)ms,which was significantly different from preoperative QRS duration(162.8±17.0)ms(P<0.05).The standard deviation of time-to-peak contraction velocity in 12 left ventricular segments was(41.5±7.6)ms and interventricular mechanical delay was(19.5±5.9)ms during pacing,which were significantly different from those 10 min later after pacing was stopped[(58.7±15.8)ms,(50.0±9.3)ms](P<0.05).NYHA class was improved 6 months later after the operation than before the operation(P<0.05)Conclusion LBBP-CRT has a certain effect on patients with heart failure and CLBBB uncorrected with HBP.

关 键 词：希氏束 心脏再同步治疗 束支传导阻滞 

分 类 号：R541.7[医药卫生—心血管疾病] R541.6[医药卫生—内科学]