双定位法左束支区域起搏的可行性和安全性研究  

Safety and efficacy of left bundle branch area pacing via dual localization

作　　者：刘文武 梁晋 陈成[1] 武雯婷 钱钧[2] LIU Wenwu;LIANG Jin;CHEN Cheng;WU Wenting;QIAN Jun(Department of Cardiology,Suzhou of TCM Hospital affiliated to Nanjing University of Chinese Medicine,Suzhou 215009;Department of Cardiology,Maanshan Central Hospital,Maanshan 243099,China)

机构地区：[1]南京中医药大学附属苏州市中医医院心血管内科,215009 [2]马鞍山市中心医院心血管内科,243099

出　　处：《国际心血管病杂志》2023年第5期317-321,共5页International Journal of Cardiovascular Disease

基　　金：苏州市科技计划项目(SLT201962)。

摘　　要：目的:探讨双定位法左束支区域起搏(LBBaP)的可行性及安全性。方法:回顾性纳入2020年1月至2020年12月于马鞍山市中心医院接受LBBaP的105例缓慢性心律失常患者,手术成功患者分为常规法LBBaP植入组(t-LBBaP组,n=46)和双定位法LBBaP植入组(d-LBBaP组,n=59)。比较2组基线临床资料、手术相关指标、术中和随访1年期间起搏器参数和并发症情况。结果:在105例患者中,99例成功行LBBaP,成功率94.3%。t-LBBaP组成功率42/46(91.3%),d-LBBaP组成功率57/59(96.6%)。d-LBBaP组电极植入尝试次数[(1.89±0.88)次对(2.64±1.01)次]、X线曝光时间[(9.22±4.27)min对(13.34±5.47)min)]、手术时间[(86.32±10.10)min对(95.29±15.90)min]、术后3 d肌钙蛋白水平均明显低于t-LBBaP组(P均<0.05)。t-LBBaP组术后6个月起搏器阈值较术中上升,d-LBBaP组术后1个月、t-LBBaP组术后6个月起搏器感知较术中上升,2组术后6个月起搏器阻抗较术中下降(P均<0.05)。随访过程中2组间起搏器阈值、感知、阻抗等参数的差异无统计学意义。2组术中及术后随访1年的并发症的差异无统计学意义。结论:双定位法LBBaP可以准确判断电极位置,操作简单,成功率高,是安全、可行的生理性起搏方式。Objective:To investigate the safety and efficacy of left bundle branch area pacing(LBBaP)via dual localization.Methods:A total of 105 patients with chronic brady-arrhythmias who received LBBaP in Maanshan Central Hospital from January to December 2020 were retrospectively enrolled and patient with successful surgery were divided into two groups based on LBBaP with double localization(LBBaP-d group,n=59)and LBBaP with traditional method(LBBaP-t group,n=46).Baseline clinical characteristics,procedure-related features,and pacemaker parameters at one-year follow-up,and post-procedure complications were collected.Results:Overall,LBBaP was successful in 99 patients(94.3%).The success rate was 91.3%in LBBaP-t group(42/46 patients)and 96.6%in LBBaP-d group(57/59 patients).Compared with LBBaP-t group,number of attempts for electrode implantation was lower(1.89±0.88 vs.2.64±1.01,P<0.001),X-ray exposure time(9.22±4.27 min vs.13.34±5.47 min,P<0.001)and procedural time(86.32±10.10 min vs.95.29±15.90 min,P=0.001)were shorter and serum level of cTnT within the initial 3 days post procedure was lower in LBBaP-d group(all P<0.001).Compared the measurement before the procedure,pacemaker threshold was higher at 6 months in LBBaP-t group(P<0.05).Pacemakerperception was improved at 1 and 6 months in LBBaP-d group and LBBaP-t group,respectively(all P<0.05 versus that bofore the procedure).For both groups,pacemaker impedance was decreased at 6 months(P<0.05).At 12 months of follow-up,all pacemaker parameters remained stable in the two groups.Post-procedure complications were not significantly different in both groups.Conclusion:LBBaP with doublelocalization is a safe and feasible physiological pacing method,with accurate positioning,simple operation and high success rate.

关 键 词：左束支区域起搏 双定位法 可行性 生理性起搏 

分 类 号：R654.2[医药卫生—外科学]