左束支起搏与右室间隔起搏有效性与安全性对比分析  

Comparative Analysis of Effectiveness and Safety of Left Bundle Branch Pacing and Right Ventricular Septum Pacing

作　　者：杨洵杰 翁兰 林姗婴 叶子聪 朱春瑜 林春艺[1] YANG Xunjie;WENG Lan;LIN Shanying;YE Zicong;ZHU Chunyu;LIN Chunyi(Department of Cardiovascular Medicine,Zhangzhou Municipal Hospital of Fujian Province,Zhangzhou Fujian 363001,China)

机构地区：[1]福建省漳州市医院心血管内科,福建漳州363001

出　　处：《中国卫生标准管理》2023年第9期90-95,共6页China Health Standard Management

摘　　要：目的探讨左束支起搏(left bundle branch pacing,LBBP)技术与右室间隔起搏(right ventricular septal pacing,RVSP)技术有效性与安全性对比分析。方法 回顾性分析2019年1月—2021年12月福建省漳州市医院收治的129例病态窦房结综合征(sick sinus syndrome,SSS)或房室阻滞(atrioventricular block,AVB)患者的临床资料,61例采用LBBP(LBBP组),68例采用RVSP(RVSP组)。记录两组起搏情况,比较两组术中及术后3个月、术后1年的起搏参数(包括起搏阈值、起搏感知、起搏阻抗)和超声心动图、心电图表现,并观察两组患者术中及术后并发症发生情况。结果 LBBP组患者术中心室感知及心室电极阻抗均较RVSP组高,差异有统计学意义(P <0.05);心室起搏阈值两组间差异无统计学意义(P> 0.05)。LBBP组脉冲-左心室达峰时间(stimulus to left ventricular activation time,Sti-LVAT)为(70.73±11.85)ms,RVSP组Sti-LVAT时限未检测。术后3个月及术后1年起搏参数结果与术中一致。术后1年时,行超声心动图及常规心电图检查,LBBP组与RVSP组超声心动图参数:左室舒张末期容积(left ventricular end diastolic volume,LVEDD)及左室射血分数(left ventricular ejection fraction,LVEF)差异无统计学意义(P> 0.05),常规心电图QRS时限差异无统计学意义(P> 0.05)。两组间并发症发生率差异无统计学意义(P> 0.05)。结论 LBBP成功率高,起搏参数理想,未引起严重并发症,具有更好的感知参数,对LVEF及QRS波宽度的影响较小,可考虑作为高比例起搏患者的首选治疗方案。Objective Comparison of feasibility and safety in left bundle branch pacing(LBBP)and right ventricular septal pacing(RVSP).Methods The clinical data of 129 patients with sick sinus syndrome(SSS)or atrioventricular block(AVB)Retrospective analysis of the clinical data of 129 patients with sick sinus syndrome or atrioventricular block admitted to Zhangzhou Municipal Hospital of Fujian Province from January 2019 to December 2021 were analyzed retrospectively,including 61 cases receiving LBBP(LBBP group)and 68 cases receiving RVSP(RVSP group).The pacing conditions of the two groups were recorded.The pacing parameters(including pacing threshold,pacing perception,pacing impedance),echocardiography and electrocardiogram during operation,3 months and 1 year after operation were compared between the two groups.The incidence of intraoperative and postoperative complications was observed in both groups.Results The pacing perception and pacing impedance in the LBBP group were higher than those in the RVSP,the difference was statistically significant(P<0.05).There were no statistically significant differences between the two groups in pacing threshold(P>0.05).The stimulus to left ventricular activation time(Sti-LVAT)in the LBBP group was(70.73±11.85)ms,while was not detected in the RVSP group.The results of pacing parameters at 3 months and 1 years after operation were consistent with those during operation.There were no statistically significant differences between the two groups in echocardiographic parameters[left ventricular end diastolic volume(LVEDD),left ventricular ejection fraction(LVEF)]or QRS complex 1 years after operation(P>0.05).There was no significant difference in complication rate between the two groups(P>0.05).Conclusion LBBP has high success rate,ideal pacing parameters,no serious complications,better perception parameters,and less impact on LVEF and QRS complex.It can be considered as the first choice for patients with high proportion of pacing.

关 键 词：左束支起搏 右室间隔起搏 有效性 安全性 病态窦房结综合征 房室传导阻滞 

分 类 号：R541[医药卫生—心血管疾病]