左束支起搏与传统右室起搏对房室传导阻滞患者近期疗效观察及安全性评估  

Evaluation of efficacy and safety of left bundle branch pacing and traditional right ventricular pacing in patients with atrioventricular block

作　　者：陈良川[1] 徐璐[1] 朱贤关[1] 项学军[1] 郑元喜[1] 乔锐[1] CHEN Liangchuan;XU Lu;ZHU Xianguan;XIANG Xuejun;ZHENG Yuanxi;QIAO Rui(Department of Cardiovascular Medicine,Anqing Hospital,Anhui Medical University,Anhui Province,Anqing 246000,China)

机构地区：[1]安徽医科大学附属安庆医院心血管内科,安徽安庆246000

出　　处：《中国医药导报》2023年第26期76-81,共6页China Medical Herald

基　　金：安徽省安庆市科技局项目(2020Z4010)。

摘　　要：目的比较左束支起搏与传统右室起搏对房室传导阻滞患者近期疗效及安全性。方法选择安徽医科大学附属安庆医院2020年1月至2021年6月因房室传导阻滞入住心内科并行心脏起搏器植入术的患者作为研究对象,共174例。按照随机数字表法将其分为传统右室起搏组(行右室心尖部起搏)和左束支起搏组(行左束支起搏),各87例。比较两组术中及术后1、12个月左室舒张末期内径(LVEDD)、射血分数(LVEF)、血清B型脑钠肽(BNP)、起搏参数阈值、阻抗、感知、QRS波时限,以及左心室12节段标准差(Tsd-12-LV)和左心室侧壁基底段与右心室游离壁基底段Ts之差(Ts-LV-RV),左心室充盈时间(LVFT)与RR间期比值(LVFT/RR)及手术时间、射线曝光时间,射线剂量及患者并发症情况。结果传统右室起搏组术后12个月LVEDD和BNP水平高于术前和术后1个月,差异有统计学意义(P<0.05);左束支起搏组术后12个月BNP水平低于同期传统右室起搏组,差异有统计学意义(P<0.05)。两组不同时间点阈值比较,差异有统计学意义(P<0.05),两组术后12个月感知能力高于术中和术后1个月,差异有统计学意义(P<0.05);左束支起搏组术中,术后1、12个月QRS波时限水平低于同期传统右室起搏组,差异有统计学意义(P<0.05)。两组术后12个月Tsd-12-LV、Ts-LV-RV及LVFT/RR值低于术前,差异有统计学意义(P<0.05);传统右室起搏组术后12个月LVFT/RR值低于术后1个月,差异有统计学意义(P<0.05);左束支起搏组术后12个月Ts-LV-RV值、LVFT/RR值低于术后1个月,差异有统计学意义(P<0.05)。左束支起搏组术后12个月Tsd-12-LV、Ts-LV-RV及LVFT/RR均低于同期传统右室起搏组,差异有统计学意义(P<0.05);左束支起搏组术后1个月Ts-LV-RV值低于同期传统右室起搏组,差异有统计学意义(P<0.05)。左束支起搏组手术时间、射线曝光时间长于传统右室起搏组,且射线剂量高于传统右室起搏组,差异有统计�Objective To compare the efficacy and safety of left bundle branch pacing and conventional pacing in patients with atrioventricular block.Methods A total of 174 patients with atrioventricular block who were admitted to the Department of Cardiology,Anqing Hospital,Anhui Medical University and underwent cardiac pacemaker implantation from January 2020 to June 2021 were selected as the research objects.The patients were divided into the traditional right ventricular pacing group(right ventricular apex pacing)and the left bundle branch pacing group(left bundle branch pacing)according to random number table method,with 87 cases in each group.Left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),serum brain natriuretic peptide(BNP),pacing parameter threshold,impedance,perception,and QRS duration were compared between the two groups during operation,1 month,and 12 months after surgery.The left ventricle 12 segments Ts standard deviation(Tsd-12-LV)and the difference between left ventricular lateral wall base segments and right ventricular free wall base systolic velocity peak time(Ts)(Ts-LV-RV),left ventricular filling time(LVFT)and RR interval ratio(LVFT/RR),as well as operation time,radiation exposure time,radiation dose,and patient complications.Results LVEDD and BNP levels in traditional right ventricular pacing group 12 months after surgery were higher than those before surgery and one month after surgery,and the differences were statistically significant(P<0.05);BNP level in left bundle branch pacing group 12 months after operation was lower than that in traditional right ventricular pacing group,and the difference was statistically significant(P<0.05).There were statistically significant differences in threshold comparison between two groups at different points,and the perceptual ability 12 months after surgery was higher than that during surgery and one month after surgery,the differences were statistically significant(P<0.05);the duration of QRS wave in left bundle branch pacing

关 键 词：房室传导阻滞 左束支起搏 传统右室起搏 疗效 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]