左束支传导阻滞犬模型行左束支区域起搏的实验研究  

Left bundle branch area pacing in left bundle branch block canine model by radiofrequency ablation of left bundle branch:an in vivo study

作　　者：蔡迟 华伟 黄灏 邓宇 程思静 牛红霞 刘曦 宁小晖 王靖 丁立刚 楚建民 张澍 Cai Chi;Hua Wei;Huang Hao;Deng Yu;Cheng Sijing;Niu Hongxia;Liu Xi;Ning Xiaohui;Wang Jing;Ding Ligang;Chu Jianmin;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院心律失常中心,北京100037

出　　处：《中华心律失常学杂志》2022年第6期572-577,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(82070349);中央高校基本科研业务费专项资金(3332020016)。

摘　　要：目的建立左束支传导阻滞(LBBB)犬模型,探讨左束支区域起搏(LBBAP)纠正LBBB的可行性及有效性。方法研究选取6只比格犬,雌雄各半,体重(17.7±1.4)kg,在X线影像及三维模型指导下,应用压力消融导管经主动脉逆行途径标测并消融左束支。成功建立LBBB模型后,在X线影像指导下进行LBBAP。分析LBBAP的起搏参数和左心室达峰时间,并比较LBBAP前后的QRS波形态和时限。结果6只犬均成功建立LBBB模型,其中5只犬成功进行LBBAP,1只犬因心室导线无法旋入室间隔致导线植入失败。LBBAP起搏阈值感知参数良好,LBBAP的左心室达峰时间明显缩短(48.2±2.5)ms,LBBAP前后QRS时限变化差异有统计学意义[(118.4±3.2)ms对(57.6±3.2)ms,(P<0.001)]。结论成功建立LBBB犬模型。LBBAP能够有效纠正LBBB,具有较高的可行性。Objective To explore the feasibility and efficacy for left bundle branch area pacing(LBBAP)in left bundle branch block(LBBB)canine model.Methods A total of 6 canines of half male and half female,about(17.7±1.4)kg in weight,were included in our study.Using X-ray and 3-dimensional electroanatomic mapping system,the mapping and radiofrequency catheter ablation(RFCA)of left bundle branch were performed using contact force-sensing catheter via a retrograde aortic approach.After LBBB canine model was successfully established,LBBAP was conducted using X-ray imaging.The pacing parameters and stimulus to left ventricular activation time(S-LVAT)of LBBAP were analyzed,and QRS morphology and duration before and after LBBAP were recorded and compared.The successful LBBB-correction rate of LBBAP was also analyzed.Results LBBB model were successfully established in all the 6 canines.There were 5 of 6 canines underwent successful LBBAP,and the remaining 1 canine failed because the ventricular lead could not be screwed into the interventricular septum.The pacing and sensing parameters were fine.The mean S-LVAT of LBBAP was(48.2±2.5)ms,and the QRS duration before and after LBBAP were significantly different[(118.4±3.2)ms vs.(57.6±3.2)ms,P<0.001].Conclusion Our results suggest the LBBB canine model by RFCA of left bundle branch can be effectively corrected by LBBAP.

关 键 词：心脏起搏 人工 左束支传导阻滞 左束支区域起搏 射频导管消融 犬 

分 类 号：R541.7[医药卫生—心血管疾病] R-332[医药卫生—内科学]