判断左束支起搏成功夺获标准的研究进展  

Criteria for Determining Successful Capture of Left Bundle Branch Pacing

作　　者：岳岸娜 钱步云 陈璐[1] 孙康云[1] 邹建刚[2] YUE Anna;QIAN Buyun;CHEN Lu;SUN Kangyun;ZOU Jiangang(Department of Cardiology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215008,Jiangsu,China;Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院心血管内科,江苏苏州215008 [2]南京医科大学第一附属医院心血管内科,江苏南京210029

出　　处：《心血管病学进展》2024年第4期289-294,共6页Advances in Cardiovascular Diseases

摘　　要：左束支起搏(LBBP)定义为起搏夺获左束支,包括左束支主干及其分支,伴或不伴周围心肌夺获,且夺获阈值一般不超过1.5 V/0.4 ms。记录到逆行希氏束电位或顺行左束支电位是左束支夺获的直接证据,但该操作较为复杂,临床使用较少。在起搏导线植入过程中,通常根据心电图变化来判断导线是否成功夺获左束支,具体包括体表心电图QRS波群形态、左心室达峰时间变化、腔内心电图检测到左束支电位或损伤电流,以及改变起搏输出时观察到非选择性LBBP转换到选择性LBBP或左心室间隔部起搏等。由于患者存在个体差异,一些学者提出了个体化的左心室达峰时间、V_(6)-V_(1)峰值间期以及LBBP评分等方法进一步补充了夺获标准。现对目前常用的标准进行分析总结,为临床操作提供更多依据,以提高LBBP手术成功率。Left bundle branch pacing(LBBP)is defined as the capture of the left bundle branch by pacing,including the capture of left bundle branch trunk and its branches(with or without peripheral myocardial)and the low capture threshold(less than 1.5 V/0.4 ms).The recording of retrograde His bundle potential or anterograde left bundle branch potential is the direct evidence of left bundle branch capture,but the operation is more complex and less used in clinical practice.During pacemaker lead implantation,electrocardiogram(ECG)changes are usually used to determine whether the lead successfully captured the left bundle branch.Specifically,it includes changes in the shape of QRS wave in body surface ECG,changes in left ventricular activation time,detection of left bundle branch potential or injury current in intracavitary ECG,and observation of non-selective LBBP switching to selective LBBP or left ventricular septal pacing when pacing output is changed.Due to individual differences in patients,some scholars have proposed personalized methods such as left ventricular peak time,V_(6)-V_(1)peak interval,and LBBP score to further supplement the capture criteria.This review aims to summarize the commonly used criteria at present and provide more evidence for clinical operation to improve the success rate of LBBP surgery.

关 键 词：左束支起搏 左束支夺获标准 左束支电位 损伤电流 左心室激动时间 

分 类 号：R54[医药卫生—心血管疾病]