左束支起搏在纠正完全性左束支传导阻滞治疗心力衰竭中电极参数稳定性研究  

Research on stability of lead parameters by left bundle branch pacing among patients with heart failure and left bundle branch BLOCK

作　　者：许国卿 梁延春 高阳 刘荣 武敏 徐白鸽 李佳霖 于海波 XU Guo-qing;LIANG Yan-chun;GAO Yang;LIU Rong;WU Min;XU Bai-ge;LI Jia-lin;YU Hai-bo(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2024年第5期468-472,共5页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划项目(2020JH2/10300165)。

摘　　要：目的 探讨左束支起搏(LBBP)纠正完全性左束支传导阻滞(CLBBB)治疗心力衰竭患者电极参数是否稳定。方法 选取自2019年1月至2020年6月在北部战区总医院心血管内科住院的具备心脏再同步化治疗适应症的心力衰竭伴CLBBB(QRS波时限≥150 ms)且左心室射血分数≤35%的22例窦性心律患者为研究对象。所有入选患者均知情同意应用LBBP纠正CLBBB且手术成功。记录患者术后即刻及术后1、6、12、24、36个月LBBP纠正CLBBB的电极参数(阈值及阻抗)变化。随访观察LBBP纠正CLBBB患者的电极参数特点。结果 22例患者均成功植入LBBP电极且能完全纠正CLBBB,其术后1、6、12、24、36个月各时间点的起搏阈值比较及其与术后即刻起搏阈值比较,差异均无统计学意义(P>0.05),无起搏阈值>2.5 V/0.4 ms者。22例患者术后1、6、12、24、36个月各时间点的阻抗比较,差异均无统计学意义(P>0.05),且均稳定在正常值范围;但均低于术后即刻的阻抗,差异有统计学意义(P<0.05)。术后起搏QRS波时限为(114.09±13.68)ms,较术前的(168.18±9.06)ms明显缩窄,差异有统计学意义(P<0.05)。随访期内未发生纠正CLBBB起搏失夺获、3830导线移位、穿孔、重置或拔除,无心力衰竭再住院及死亡风险。结论 LBBP导线纠正CLBBB参数满意且3年内稳定性与安全性良好,LBBP可明显缩窄QRS波时限,改善心室激动的同步性,达到生理性起搏改善心力衰竭的目的。对于心力衰竭伴CLBBB患者,LBBP可作为纠正CLBBB的一种合理选择。Objective To investigate the stability of electrode parameters in patients with heart failure treated with complete left bundle branch block(CLBBB)corrected by left bundle branch pacing(LBBP).Methods A total of 22 patients with sinus rhythm with heart failure with CLBBB(QRS duration≥150 ms)and left ventricular ejection fraction ≤35% who were admitted to the Department of Cardiology of General Hospital of Northern Theater Command from January 2019 to June 2020 for cardiac resynchronization treatment indications were selected as the study subjects.All enrolled patients gave informed consent to use LBBP to correct CLBBB and the operation was successful.Electrode parameters(threshold and impedance)of LBBP for the correction of CLBBB were recorded immediately after surgery and at 1,6,12,24,36 months after surgery.The electrode parameters of LBBP for the correction of CLBBB were followed up.Results All the 22 patients were successfully implanted with LBBP electrodes and CLBBB could be completely corrected.There was no statistical significance in pacing threshold values at each time point 1,6,12,24,36 months after surgery and compared with pacing threshold values immediately after surgery(P>0.05),and no pacing threshold values more than 2.5 V/0.4 ms.There was no significant difference in the impedance of 22 patients at 1,6,12,24 and 36 months after operation(P>0.05),and all were stable in the normal range, however, they were all lower than the immediate postoperative impedance, and the difference was statistically significant(P<0.05).The QRS duration of postoperative pacing was(114.09±13.68)ms, which was significantly narrower than that of preoperative QRS duration(168.18±9.06)ms, and the difference was statistically significant(P<0.05).No corrective CLBBB pacing loss, 3830 lead displacement, perforation, reset, or removal occurred during follow-up, and there was no risk of heart failure rehospitalization or death.Conclusion The electrode parameters of LBBP for the correction of CLBBB is satisfied and has good sta

关 键 词：窦性心律 左束支起搏 完全性左束支传导阻滞 心功能不全 电极参数 

分 类 号：R541.6[医药卫生—心血管疾病]