左束支区域起搏与右室间隔部起搏对房室传导阻滞患者新发房颤及心功能影响的对比  

Effects of left bundle branch area pacing or right ventricular septal pacing on new-onset atrial fibrillation and cardiac functions in patients with atrioventricular block

作　　者：刘靖 林苏华[1] 李煜[1] 许健 林镇国 LIU Jing;LIN Su-hua;LI Yu;XU Jian;LIN Zhen-guo(Department of Cardiac Function,Zhongshan Hospital,Xiamen University,Xiamen 361004,Fujian,China;Department of Clinical Medicine,Xiamen Medical College,Xiamen 361023,Fujian,China)

机构地区：[1]厦门大学附属中山医院心功能科,福建厦门361004 [2]厦门医学院临床医学系,福建厦门361023

出　　处：《心脏杂志》2023年第2期168-172,共5页Chinese Heart Journal

摘　　要：目的探讨左束支区域起搏(LBBAP)对高心室起搏比例患者中远期新发房颤及心功能影响。方法以因II度以上房室传导阻滞行DDD起搏器植入患者为研究对象,患者随机入组LBBAP高心室起搏比例组(LBBAPhigh组)、右室间隔部起搏(RVSP)高心室起搏比例组(RVSP-high组)、RVSP低心室起搏比例组(RVSP-low组)。随访内容包括:各随访节点心房频率大于180次/min、持续时间大于1 min且发生自动模式转换(AMS)事件、动态心电图、超声心动图参数、NT-proBNP水平。分析三组患者的临床基本特征,使用Kaplan-meier法绘制患者新发房颤的时间曲线,并采用COX比例风险模型进行多因素相关性分析。对比三组患者半年期心超参数与NTproBNP水平。结果与LBBAP-high组比较,起搏QRS宽度RVSP-low组升高(P<0.01),RVSP-high组升高(P<0.01)。随时间延长,患者术后新发房颤发生率逐渐增高。三组患者记录到房颤事件共有59例(57%),其中,LBBAP-high组15例(44%)、RVSP-low组11例(38%)、RVSP-high组33例(82%)。RVSP-high组患者新发房颤比率比LBBAP-high组及RVSP-low组显著增高(P<0.01)。以False Discovery Rate(FDR)法进行两两比较:LBBAP-high组和RVSP-high组组间的窦律保持率差异存在统计学意义(P<0.01);RVSP-high组和RVSP-low组组间的窦律保持率差异存在统计学意义(P<0.01)。LBBAP-high组和RVSP-low组组间的窦律保持率差异不存在统计学意义。COX单因素回归分析显示,高起搏比例的右室间隔部起搏(HR=3.004;95%CI:1.615~5.586;P<0.01)、低射血分数(HR=1.029;95%CI:1.004~1.054;P<0.05)及高血压(HR=1.889;95%CI:1.05~3.40;P<0.05)是术后新发房颤的独立危险因素。多因素回归分析显示,仅高比例的右室间隔部起搏(HR=5.572;95%CI:2.444~12.701;P<0.01)及高血压(HR=2.752;95%CI:1.342~5.642;P<0.05)是术后新发房颤的独立危险因素。术后半年随访,与LBBAP-high组(223±63)pg/mL比较,RVSP-high组(752±54)pg/mL的NT-proBNP水平升高(P<0.01);与RVSP-low组(AIM To investigate the effect of left bundle branch area pacing(LBBAP)on the incidence of new onset atrial fibrillation(AF)and on cardiac functions in patients with medium or long-term high proportion of ventricular pacing.METHODS Patients with atrioventricular block and indication for pacing were recruited and randomly assigned to LBBAP high ventricular pacing group(LBBAP-high Group),right ventricular septal pacing(RVSP)high ventricular pacing group(RVSP-high group)or RVSP low ventricular pacing group(RVSP-low group).Patients were followed up at 3 months,6 months and every 6 months after the operations.The atrial high rate events(AHREs)documented by pacemaker,with frequency greater than 180 beats per minute,duration greater than 1 minute and automatic mode conversion(AMS)occurrence were recorded and deemed as AF events.AHREs,AF events documented by Holter monitor,echocardiography parameters,and NT-proBNP levels at each follow-up point were recorded.Kaplan-meier method was applied to draw the time curve of AF in each group and COX proportional hazard model was applied to analyze the correlation of multiple factors with new-onset AF.RESULTS Compared with LBBAP high group,QRS width of pacing increased in RVSP low group(P<0.01)and RVSP high group(P<0.01).The incidence of new atrial fibrillation increased with time.A total of 59 cases(57%)of atrial fibrillation events were recorded in the three groups,including 15 cases(44%)in LBBAP high group,11 cases(38%)in RVSP low group,and 33 cases(82%)in RVSP high group.The rate of new atrial fibrillation in RVSP high group was significantly higher than that in LBBAP high group and RVSP low group(P<0.01).The false discovery rate(FDR)method was used to compare two groups:the sinus rhythm retention rate between LBBAP high group and RVSP high group was statistically significant(P<0.01);There was significant difference in sinus rhythm retention rate between RVSP high group and RVSP low group(P<0.01).There was no significant difference in sinus rhythm retention between LBBAP high gr

关 键 词：心房颤动 左束支区域起搏 右室间隔部起搏 

分 类 号：R541.7[医药卫生—心血管疾病]