经胸超声心动图联合X线引导左束支区域起搏导线植入的探索  

Exploration of Left Bundle Branch Pacemaker Implantation Guided by Transthoracic Echocardiography Combined with X-ray

作　　者：陶瑾 杨智涵 李慕子 王剑鹏 朱振辉 刘志敏 王浩[1] TAO Jin;YANG Zhihan;LI Muzi;WANG Jianpeng;ZHU Zhenhui;LIU Zhimin;WANG Hao(Department of Echocardiography,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Center of Arrhythmia,National Center for Cardiovascular Diseases,Fuwai Hospital,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、阜外医院、国家心血管病中心、超声影像中心,北京市100037 [2]中国医学科学院、北京协和医学院、阜外医院、国家心血管病中心、心律失常中心,北京市100037

出　　处：《中国分子心脏病学杂志》2023年第2期5264-5270,共7页Molecular Cardiology of China

基　　金：中国医学科学院临床与转化医学研究基金项目(2020-I2M-C&T-A-008);阜外医院青年科学基金项目(2022-FWQN05)。

摘　　要：目的探讨经胸超声心动图联合X线引导左束支区域起搏(LBBAP)导线植入在临床应用的可行性。方法连续纳入2022年5—11月于中国医学科学院阜外医院拟行LBBAP植入术的患者共15例。应用经胸超声心动图联合X线引导的方式完成起搏器植入术。手术过程以超声引导为主,必要时经X线确认。超声引导主要包括实时监测起搏导线的走行、导线定位、导线拧入室间隔的深度。分别于术前和术后3个月采用超声心动图检查进行评价。结果15例患者起搏器植入术均顺利完成,并成功起搏左束支,无手术并发症,术后程控数据良好。经胸超声心动图联合X线引导LBBAP导线植入术X线透视时间平均2.4 min。术后3个月超声心动图随访结果提示,患者左心室舒张末期内径较术前减小[(51.0±4.3)mm vs.(48.8±3.7)mm],且差异有统计学意义(P=0.001)。结论超声心动图联合引导LBBAP导线植入可以缩短X线曝光时间,减少辐射暴露损伤,明确定位导线,减少并发症。Objective To investigate the application of transthoracic echocardiography combined with X-ray guiding pacemaker implantation in the left bundle branch area.Methodd Fifteen patients scheduled for pacemaker implantation in the left bundle branch area had pacemaker implanted with the guidance of transthoracic echocardiography combined with X-ray.Ultrasound guidance mainly included the course of pacing lead,lead positioning,depth of lead screwing into the interventricular septum.Echocardiography was performed preoperatively for the baseline and three months postoperatively.Results Pacemaker implantation was successfully completed in fifteen patients,the left bundle branch was successfully paced without surgical complications,the postoperative programming data were good,and fluoroscopy time was shortened.The follow-up results in the third month after surgery suggested that the anteroposterior diameter of left ventricular end diastole was significantly reduced compared with the baseline data before operation(P=0.001).Conclusion Echocardiography combined with X-ray-guided pacemaker implantation in the left bundle branch area can shorten the X-ray exposure time,reduce the ionizing radiation damage,precisely locate the pacing lead,reduce complications and add to the safety and efficacy of surgery,suggesting the feasibility and good prospect of application.

关 键 词：超声心动图 X线 左束支区域起搏 起搏器植入 

分 类 号：R541.7[医药卫生—心血管疾病] R540.45[医药卫生—内科学]