左束支起搏与双心室起搏对合并左束支传导阻滞心力衰竭患者的电同步性和血流动力学的影响  

Left bundle branch pacing versus biventricular pacing on electrical synchrony and hemodynamics in heart failure patients with left bundle branch block

作　　者：黄珍珍 梁义秀 汪菁峰 巩雪 肖子龙 王素华 宿燕岗 葛均波 Huang Zhenzhen;Liang Yixiu;Wang Jingfeng;Gong Xue;Xiao Zilong;Wang Suhua;Su Yangang;Ge Junbo(Department of Cardiology,Zhongshan Hospital of Fudan University,Shanghai Institute of Cardiovascular Diseases,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;Department of Cardiology,The Second People’s Hospital of Kashgar,Kashgar 844099,China;Department of Cardiology,Kashgar People’s Hospital,Kashgar 844099,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 [2]喀什地区第二人民医院心内科,喀什844099 [3]喀什市人民医院心内科,喀什844099

出　　处：《中华心律失常学杂志》2022年第5期445-449,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的比较左束支起搏(LBBP)与双心室起搏(BVP)对合并左束支传导阻滞(LBBB)心力衰竭(心衰)患者的急性电同步和左心室血流动力学的影响。方法连续性入选2020年9月至2021年3月在复旦大学附属中山医院心内科接受心脏再同步治疗(CRT)且合并LBBB的心衰患者。术中随机交叉接受LBBP和BVP,对比两种起搏模式下电同步与血流动力学的指标。电同步指标为QRS时限与QRS面积,血流动力学指标为左心室压强升高速率峰值(dP/dtmax)的增幅。结果最终18例患者纳入分析,其中男10例、女8例,年龄(67.00±9.82)岁,年龄范围47~81岁。LBBP和BVP与基线相比电同步和血流动力学均有显著改善。与BVP相比,LBBP时的QRS时限显著缩短(-12.83 ms,95%CI-20.24~-5.43 ms,P=0.002),QRS面积显著减小(-89.86μVs,95%CI-120.54~-59.17μVs,P<0.001),LBBP的左心室dP/dtmax的增幅显著高于BVP(6.86%,95%CI 3.11%~10.61%,P=0.001),差异均具有统计学意义。结论对合并LBBB的心衰患者,LBBP产生的电同步性和急性血流动力学的改善显著优于BVP。Objective To compare the acute effect of left bundle branch pacing(LBBP)and biventricular pacing(BVP)on electrical synchrony and left ventricular(LV)hemodynamics in heart failure patients with left bundle branch block(LBBB).Methods Patients with heart failure complicated with LBBB who received cardiac resynchronization therapy(CRT)in Department of Cardiology,Zhongshan Hospital from September 2020 to March 2021 were enrolled.All patients received LBBP and BVP in a random crossover fashion.Electrical synchrony was evaluated with QRS duration and QRS area,and hemodynamic was assessed with the increase of the maximum rate of LV pressure increase(dP/dtmax).Results Eighteen patients were enrolled,including 8 in female and 10 in male,with an average age of(67.00±9.82)years(47-81 years).Both LBBP and BVP showed significant improvement in electrical synchrony and hemodynamics compared to baseline.Compared with BVP,LBBP achieved a larger reduction of QRS duration(-12.83 ms,95%CI-20.24--5.43 ms,P=0.002)as well as QRS area(-89.86μVs,95%CI-120.54--59.17μVs,P<0.001).LBBP achieved a significantly higher increase in LV dP/dtmax than BVP(6.86%,95%CI 3.11%-10.61%,P=0.001).Conclusion Compared with BVP,LBBP delivered better improvement in electrical synchrony and acute hemodynamics in patients with heart failure and LBBB.

关 键 词：心力衰竭 电同步性 双心室起搏 左束支起搏 血流动力学 

分 类 号：R541.6[医药卫生—心血管疾病]