希氏-浦肯野传导系统起搏中左束支损伤电流与电极解剖定位的动物研究  

Animal study on left bundle branch current of injury and anatomic location of leads in His-purkinje conduction system pacing

作　　者：王粮萍 蒋丽梦 王松洁 吴圣杰[1] 黄周青[1] 单培仁[1] 黄伟剑[1] 苏蓝[1] Wang Liangping;Jiang Limeng;Wang Songjie;Wu Shengjie;Huang Zhouqing;Shan Peiren;Huang Weijian;Su Lan(Department of Cardiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Cardiology,Sir Run Run Shaw Hospital,Affiliated Hospital of Medical School of Zhejiang University,Shaoxing 312399,China)

机构地区：[1]温州医科大学附属第一医院心血管内科,温州325000 [2]浙江大学附属邵逸夫医院心血管内科,绍兴312399

出　　处：《中华心血管病杂志》2023年第11期1175-1180,共6页Chinese Journal of Cardiology

基　　金：浙江省卫生厅基金(2021KY787)。

摘　　要：目的探讨左束支起搏电极头端和左束支解剖位置的关系及损伤电流产生机制,阐明术中左束支损伤电流的临床价值。方法选取2只实验猪,在活体猪心植入电极,术中电生理检查明确电极低电压输出是否夺获左束支。术后猪心大体标本即刻予碘染观察左心室内膜面希氏-浦肯野(希浦)传导系统的大体分布和电极关系。随后福尔马林液固定猪心标本,标记电极位置后移除电极,切片并予以Masson及Goldner染色,观察电极头端与传导束的解剖位置关系。结果标本碘染后肉眼可见心内膜下希浦系统呈网状分布,电极头端直接深拧固定在室间隔左心室心内膜下的左束支区域。Masson及Goldner染色显示在左束支电位伴损伤电流的电极头端直接穿过左束支分支,有电位但无损伤电流时起搏电极头端与传导束未直接接触。结论在希浦传导系统起搏中,术中观察到左束支传导束损伤电流,组织解剖提示起搏电极直接接触左束支及分支,夺获阈值低。左束支损伤电流可以作为左束支夺获的重要解剖和电生理证据。ObjectiveExplore the relationship between tip of the left bundle branch pacing lead and anatomic location of left bundle branch as well as the mechanism of left bundle branch current of injury.To clarify the clinical value of left bundle branch current of injury during operation.MethodsThe pacing leads were implanted in the hearts of two living swines.Intraoperative electrophysiological study confirmed that the left bundle branch or only the deep left ventricular septum was captured at low output.Immediately after operation,the gross specimen of swine hearts was stained with iodine to observe the gross distribution of His-purkinje conduction system on the left ventricular endocardium and its relationship with the leads.Subsequently,the swine hearts were fixed with formalin solution,and the pacing leads were removed after the positions were marked.The swine hearts were then sectioned and stained with Masson and Goldner trichrome,and the relationship between the anatomic location of the conduction system and the tip of the lead was observed under a light microscope.ResultsAfter iodine staining of the specimen,the His-purkinje conduction system was observed with the naked eye in a net-like distribution,and the lead tip was screwed deeply and fixed in the left bundle branch area of the left ventricular subendocardium in the ventricular septum.Masson and Goldner trichrome staining showed that left bundle branch pacing lead directly passed through the left bundle branch when there was left bundle branch potential with left bundle branch current of injury,while it was not directly contact the left bundle branch when there was left bundle branch potential without left bundle branch current of injury.ConclusionThe left bundle branch current of injury observed on intracardiac electrocardiogram during His-purkinje conduction system pacing suggests that the pacing lead directly contacted the conduction bundle or its branches,therefore,the captured threshold was relatively low.Left bundle branch current of injury can be used

关 键 词：希氏-浦肯野传导系统起搏 左束支 损伤电流 解剖 

分 类 号：R541.7[医药卫生—心血管疾病]