左束支区域起搏与右心室间隔部起搏对心力衰竭合并心房颤动的影响  

The effects of left bundle branch pacing and right ventricular septal pacing on heart failure and atrial fibrillation

作　　者：陈奕 CHEN Yi(Hospital of the Chinese People's Armed Police Force Maritime Safety Bureau,Jiaxing 314000,China)

机构地区：[1]中国人民武装警察部队海警总队医院,浙江嘉兴314000

出　　处：《浙江实用医学》2022年第6期451-455,共5页Zhejiang Practical Medicine

摘　　要：目的 探讨左束支区域起搏(LBBP)与右心室间隔部起搏(RVSP)对心力衰竭合并心房颤动患者心衰指标、心功能的影响。方法 选取2019年1月-2021年6月在中国人民武装警察部队海警总队医院行心脏起搏器植入手术的126例心力衰竭合并房颤患者,根据起搏方法将患者分为LBBP组和RVSP组各63例,术后随访6个月,比较两组心衰指标、心功能及心脏结构改善情况。结果 两组术后1个月、3个月,心室电极起搏、阻抗及感知阈值比较差异无统计学意义(P>0.05)。术后1个月、3个月LBBP组血清肌钙蛋白(cTn)Ⅰ、血浆脑钠肽(BNP)水平低于RVSP组,差异有统计学意义(P<0.05)。LEEP组术后1个月、3个月QRS时限水平、左心室不同步指数(Ts-SD)、肺动脉射血前间期-主动脉射血间期(PPEI-APEI)低于RVSP组,差异有统计学意义(P<0.05)。LEEP组术后1个月、3个月左心室射血分数(LVEF)显著高于RVSP组,差异有统计学意义(P<0.05),而LEEP组术后1个月、3个月左心室舒张末期容积(LVEDV)、Tei指数低于RVSP组,差异有统计学意义(P<0.05)。结论 LBBP较RVSP能更好地保持心力衰竭合并心房颤动患者起搏收缩同步性,更有利于保护心功能,延缓心力衰竭,是一种更理想的生理性起搏方式。Objective To investigate the effects of left bundle branch pacing(LBBP)and right ventricular septal pacing(RVSP)on cardiac function and heart failure indices in patients with heart failure and atrial fibrillation.Methods 126 patients with heart failure and atrial fibrillation who underwent cardiac pacemaker implantation from January 2019 to June 2021 at the Hospital of the Chinese People's Armed Police Force(APF)Maritime Safety Bureau were selected,and were divided into LBBP group(n=63)and RVSP group(n=63)according to the pacing method.The improvement of cardiac function and structure,as well as heart failure indices,were compared between the two groups during the 6-month follow-up.Results There was no significant difference in the pacing impedance and sensing values of the ventricular electrode between the two groups at 1 and 3 months after surgery(P>0.05).The levels of serum creatine kinase(CK)-MB and brain natriuretic peptide(BNP)in the LBBP group were lower than those in the RVSP group at 1 and 3 months after surgery(P<0.05).The left ventricular dyssynchrony index(TS-SD)and pulmonary artery pre-ejection period to aortic pre-ejection period(PELP-APET)were lower in the LBBP group than in the RVSP group at 1 and 3 months after surgery(P<0.05).The left ventricular ejection fraction(LVEF)in the LBBP group was significantly higher than that in the RVSP group at 1 and 3 months after surgery(P<0.05).However,the left ventricular end-diastolic volume(LVEDV)and tei index were lower in the LBBP group than in the RVSP group at 1 and 3 months after surgery(P<0.05).Conclusion LBBP is more advantageous than RVSP in maintaining the synchronous contraction of the heart in patients with heart failure and atrial fibrillation,and is a more ideal physiological pacing method for delaying heart failure and protecting heart function.

关 键 词：左束支区域起搏 右心室间隔部起搏 心力衰竭 心房颤动 心衰指标 心功能 

分 类 号：R541.75[医药卫生—心血管疾病] R541.6[医药卫生—内科学]