慢性心力衰竭患者左束支起搏后植入全皮下心脏转复除颤器的可行性筛查  

Feasibility study of implanting subcutaneous implantable cardioverter-defibrillator in chronic heart failure patients after left bundle branch pacing

作　　者：曹泽众 陈鑫敏 秦朝彤 薛思源 吴雨晴 胡耿维 邹建刚 侯小锋 CAO Ze-zhong;CHEN Xin-min;QIN Chao-tong;XUE Si-yuan;WU Yu-qing;HU Gengwei;ZOU Jian-gang;HOU Xiao-feng(Division of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)心血管内科,江苏南京210029

出　　处：《中国心脏起搏与心电生理杂志》2023年第5期395-400,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金(82070521);江苏省人民医院临床能力提升项目(JSPH-MA-2022-2)。

摘　　要：目的探究慢性心力衰竭患者行左束支起搏(LBBP)后植入全皮下心脏转复除颤器(S-ICD)的可行性。方法纳入慢性心力衰竭合并左束支传导阻滞患者,分别在LBBP术后2天内和术后6个月左右使用自动筛查工具进行S-ICD的植入前合格性筛查,每次筛查分别在自身完全性左束支阻滞非起搏模式、单纯LBBP模式、自身右束支下传与LBBP融合三种模式下进行;对于经冠状静脉窦植入左室导线的患者,增加左束支与左室同步起搏模式筛查。每种模式均在坐位和卧位两种体位下进行筛查,至少有一个感知向量在两种体位下通过筛查认为该模式通过筛查。统计不同模式下的通过向量个数和筛查通过率。结果共纳入31例患者,年龄(68.0±8.3)岁,其中男性18例(56.1%)。14例植入带有除颤功能的起搏器(CRT-D),17例植入不带除颤功能的起搏器(包括13例植入DDD,4例植入CRT-P)。在术后的第一次筛查中,31名患者四种模式下筛查通过率分别为45.5%、87.1%、90.9%和100.0%(P<0.001);平均通过的向量个数为0.64±0.90、1.52±0.85、1.45±0.80、1.00±0.00(P=0.002);但LBBP参与的3种起搏模式之间筛查通过率及平均通过的向量个数无统计学差异。31例完成了术后6个月的筛查,带有除颤器和不带除颤器的两组病人初次筛查通过率分别为92.9%和82.4%,平均通过向量个数为1.43±0.76和1.59±0.94;6个月后复查通过率分别为100%和94.1%,平均通过向量个数2.00±0.78和2.00±0.87,两组病人两次筛查结果均未见差异,均保持较高的筛查通过率。结论慢性心力衰竭患者行LBBP后植入S-ICD有较高的筛查通过率,或可作为初始未植入除颤器患者的补充治疗措施。Objective To find outwhether a subcutaneous implantable cardioverter-defibrillator(S-ICD)can be used as an option for sudden cardiac death(SCD)prevention in chronic heart failure patients who have performed left bundle branch pacing(LBBP).Methods Among patients who successfully performed LBBP,proactive S-ICD screening with an automated screening tool(AST)was implemented.The screening was performed immediately after implant and during follow-up,during three modes:sinusrhythm(SR)with left bundle branch block(LBBB),LBBP only,LBBP fusion with intrinsic right bundle branch conduction,and biventricular pacing(BIVP)mode for patients with coronary sinus(CS)lead.Each mode was screened in both sitting and lying positions,and at least one vector was screened in both positions to determine if the mode passes the screening.The number of passing vectors and the screening pass rate were then calculated for different modes.Results Thirty-one patients who had chronic heart failure and LBBB were enrolled in this study.Eighteen patients received a cardiacresynchronization therapy(CRT)device(ICD 14 and pacemaker 4),and 13 patients received a dual-chamber pacemaker.At the pre-discharge screening,the pass rates in SR with LBBB,LBBP only,LBBP fusion,and BIVP modes were 45.5%,87.1%,90.9%,100.0%(P<0.001),the number of vectors in four modes were 0.64±0.90,1.52±0.85,1.45±0.80,1.00±0.00(P=0.002).There was no difference among the three modes for LBBP on pass rates and the number of passing vectors.31 patients completed the 6-month postoperative screening,with two groups of patients,one with and one without defibrillators,The initial screening pass rates were 92.9%and 82.4%,respectively,with an average pass vector count of 1.43±0.76 and 1.59±0.94.The re-examination pass rates after 6 months were 100%and 94.1%,respectively,with an average pass vector count of 2.00±0.78 and 2.00±0.87.There was no difference in the results of the two screenings,and both groups maintained a high pass rate.Conclusion The pass rate of S-ICD screening is hig

关 键 词：心血管病学 心脏再同步化治疗 心力衰竭 左束支起搏 心源性猝死 全皮下心脏转复除颤器 

分 类 号：R541.78[医药卫生—心血管疾病] R318.11[医药卫生—内科学]