高龄患者左束支区域起搏的可行性及安全性分析  

Feasibility and safety of left bundle branch area pacing in aged patients

作　　者：刘文武 梁晋 陈成[1] 戴悦晴 伍雯婷 钱钧[2] Liu Wenwu;Liang Jin;Chen Cheng;Dai Yueqing;Wu Wenting;Qian Jun(Department of Cardiovascular Medicine,Hospital of Traditional Chinese Medicine of Suzhou City,Nanjing University of Chinese Medicine,Suzhou 215007,China.;不详)

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,苏州215000 [2]马鞍山市中心医院心血管内科,马鞍山243000

出　　处：《中国循证心血管医学杂志》2024年第1期73-76,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：江苏省苏州市科技计划项目(SLT201962).

摘　　要：目的探讨高龄患者左束支区域起搏(LBBaP)的可行性及安全性。方法回顾性地分析174例在马鞍山市中心医院行LBBaP的缓慢性心律失常患者。根据年龄分为高龄组(年龄>80岁)、低龄组(60岁<年龄<80岁),比较两组基线临床资料,手术相关指标,术中及随访1年的起搏器参数,心脏彩超参数以及并发症情况,观察LBBaP在高龄患者的可行性及安全性。结果在185例患者中,174例成功行LBBaP,成功率94.1%。高龄组患者成功率与低龄组相似(93%vs.94%,P=0.805),两组术中起搏器参数无统计学差异(P>0.05)。高龄组患者在平均年龄、糖尿病、冠心病、肾功能异常、心力衰竭等合并症均高于低龄组,但均无统计学意义(P>0.05)。随访1年,高龄组阈值、感知较术中有所上升(P<0.05),阻抗有所下降(P=0.034)。低龄组感知较术中上升(P=0.001)、阻抗下降(P<0.001);两组患者左室射血分数(LVEF)均较术前提高(P<0.05),其中高龄组改善更明显(P=0.008);两组N末端脑钠肽前体(NT-proBNP)较术前明显下降(P<0.001)。两组术后起搏参数保持稳定,三尖瓣反流未有进展,手术并发症无统计学差异。结论LBBaP在高龄患者中是一种安全有效的生理性起搏方式。Objective To discuss the feasibility and safety of left bundle branch area pacing(LBBaP)in aged patients.Methods The patients with bradyarrhythmia(n=174)undergone LBBaP were retrospectively analyzed in Central Hospital of Ma`anshan City.All patients were divided,according to their age,into aged group(age>80)and younger group(60<age<80).The clinical baseline materials,indexes related to surgery,pacemaker parameters during surgery and after follow-up for 1 y,echocardiographic parameters and complications were compared between 2 groups.The feasibility and safety of LBBaP were observed in aged patients.Results Among 185 patients,there were 174 had successful LBBaP and success rate was 94.1%.The success rate in aged group was similar to that in younger group(93%vs.94%,P=0.805),and pacemaker parameters during surgery had no statistical difference between 2 groups(P>0.05).The average age and percentages of complications including diabetes,coronary heart disease,abnormal renal function and heart failure were higher in aged group than those in younger group(P>0.05).After followed up for 1 y,the threshold and perception increased(P<0.05)and impedance decreased(P=0.034)in aged group during surgery,and perception increased(P=0.001)and impedance decreased(P<0.001)in younger group during surgery.The left ventricular ejection fraction(LVEF)increased in 2 groups than before surgery(P<0.05),which was more significant in aged group(P=0.008).The level of N-terminal pro-brain natriuretic peptide(NT-proBNP)decreased significantly in 2 group than before surgery(P<0.001).The pacing parameters remained stable,tricuspid regurgitation had no development in 2 groups,and complication had no statistical difference between 2 groups.Conclusion LBBaP is a safe and effective physiological pacing method for aged patients.

关 键 词：左束支区域起搏 高龄 生理性起搏 

分 类 号：R541.75[医药卫生—心血管疾病]