右心室造影辅助左束支区域起搏的应用效果研究  

Study on application effect of right ventriculography to assist pacing in left bundle branch region

作　　者：王建灵 何江[1] 李健[1] 梁超[1] 罗传毅 淡雪川[1] 李奎[1] WANG Jianling;HE Jiang;LI Jian;LIANG Chao;LUO Chuanyi;DAN Xuechuan;LI Kui(Department of Cardiology,Yibin Municipal Second People’s Hospital,Yibin,Sichuan 644000,China)

机构地区：[1]宜宾市第二人民医院心内科,四川宜宾644000

出　　处：《重庆医学》2024年第12期1802-1806,共5页Chongqing medicine

基　　金：四川省宜宾市科技计划项目(2021SF002)。

摘　　要：目的研究右心室造影(RVG)辅助左束支区域起搏(LBBaP)的可行性和安全性。方法采用回顾性研究,纳入2019年1月至2022年6月在该院接受LBBaP的67例患者作为研究对象。收集患者基本信息,包括性别、年龄、临床诊断和心电图参数等。采用RVG三段法辅助LBBaP,具体操作为在右前斜30°透视下进行RVG,将三尖瓣瓣环最高点至右心室心尖部之间连一直线,然后将直线分为3等份,近中段交界处为LBBaP电极植入区域。术中同时满足单极起搏QRS波呈右束支阻滞形态,QRS波宽度(QRSd)<130 ms且V5导联左心室刺激到激动达峰时间(S-pLVAT)<90 ms,则定义为LBBaP手术成功。记录手术相关参数和并发症发生情况。术后1、3、6、12个月进行随访,记录电极参数、心电图和心脏彩色多普勒超声结果。结果67例患者中,男43例,年龄为(65.0±8.0)岁;22例(32.8%)患者为病态窦房结综合征,45例(67.2%)患者为二度Ⅱ型及以上房室传导阻滞。术前QRSd为(103.0±22.0)ms。LBBaP手术成功61例(91.0%)。手术时间为(134.6±32.3)min,X射线曝光时间为(43.6±12.6)min。起搏阈值为(0.8±0.4)V,R波感知振幅为(12.1±4.7)mV,阻抗为(741.2±130.8)Ω。在1 V起搏时,V5导联S-pLVAT为(83.4±13.7)ms。术后QRSd为(116.5±18.3)ms。术中8例发生室间隔穿孔,1例发生束支损伤,无其他严重并发症。随访12个月,所有患者电极参数稳定。结论RVG三段法辅助LBBaP是一种简单、可行且安全的生理性起搏方法。Objective To study the feasibility and safety of right ventricular angiography(RVG)to assist pacing in the left bundle branch region(LBBaP).Methods The retrospective study was adopted.A total of 67 patients receiving LBBaP in this hospital from January 2019 to June 2022 were included as the study subjects.The basic information of the patients was collected,including the sex,age,clinical diagnosis,EKG parameters,etc.The RVG three-stage adjuvant LBBaP was adopted.The specific operation was to perform RVG under the right anterior oblique perspective of 30°.A straight line was connected between the highest point of the tricuspid valvular ring and the apex of the right ventricle,and then the straight line was divided into 3 equal parts.The proximal junction was the LBBaP electrode implantation area.The success of LBBaP operation was defined as the simultaneous satisfaction of right bundle branch block form of QRS wave in unipolar pacing,QRS wave width(QRSd)<130 ms and peak time of left ventricular excitation<90 ms.The operation related parameters and occurrence situation of complications were recorded.The follow up was conducted in 1,3,6,12 months.The electrode parameters,electrocardiogram and color Doppler ultrasound results were recorded.Results Among 67 patients,43 cases were males aged(65.0±8.0)years old;twenty-two cases(32.8%)were symptomatic sick sinus syndrome,and 45 cases(67.2%)were second-degree typeⅡand above atrioventricular block.The preoperative QRS width(QRSd)was(103.0±22.0)ms.The LBBaP operation success was in 61 cases(91.0%).The operation time was(134.6±32.3)min,and the X-ray exposure time was(43.6±12.6)min.The pace-making threshold value was(0.8±0.4)V,the R wave perception amplitude was(12.1±4.7)mV,and the impedance was(741.2±130.8)Ω.At 1 V pacing,the peak time of left ventricular activation in the lead V5 was(83.4±13.7)ms.The postoperative QRSd was(116.5±18.3)ms.During the operation,8 cases developed interventricular septal perforation and 1 case developed bundle branch injury.No other s

关 键 词：右心室造影 心脏起搏器 生理性起搏 左束支区域起搏 

分 类 号：R459.9[医药卫生—治疗学]