房室结消融联合左束支起搏治疗心房颤动合并心力衰竭的效果  

Efficacy of atrioventricular node ablation combined with left bundle branch pacing in the treatment of atrial fibrillation complicated with heart failure

作　　者：刘曦 李骁 张磊 梁义秀 柏瑾 王蔚 汪菁峰 秦胜梅 陈学颖 宿燕岗 葛均波 Liu Xi;Li Xiao;Zhang Lei;Liang Yixiu;Bai Jin;Wang Wei;Wang Jingfeng;Qin Shengmei;Chen Xueying;Su Yangang;Ge Junbo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,China National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科、上海市心血管病研究所、国家放射与治疗临床医学研究中心,上海200032

出　　处：《中华心律失常学杂志》2024年第3期218-223,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(82170387);复旦大学附属中山医院青年基金(专培2022-007)。

摘　　要：目的探讨心房颤动(房颤)合并心力衰竭(心衰)患者中行房室结消融联合左束支起搏(LBBP)的可行性及治疗效果。方法本研究为前瞻性观察研究,纳入2021年1月至2022年12月复旦大学附属中山医院心内科因房颤、药物控制心室率欠佳,采用房室结消融联合LBBP治疗的心衰患者,观察手术参数、起搏器参数及超声心动图参数等。结果纳入30例患者,年龄(64.5±12.8)岁,其中男21例,心室率为(105.2±16.4)次/min。术中透视影像下LBBP导线与消融靶点间的距离为(22.8±5.3)mm。LBBP术后起搏QRS时限较术前显著缩短[(128.9±10.2)ms对(145.2±38.2)ms,P=0.030]。起搏器参数方面,LBBP术后阈值为(0.9±0.3)V/0.4 ms,R波感知为(7.7±4.0)mV,阻抗为(537.5±72.8)Ω,阈值及R波感知在6个月随访时保持稳定,阻抗较前显著降低(P<0.001),随访中未记录到阈值升高及起搏失夺获等并发症。术后6个月超声心动图随访显示,左心室射血分数(39.4%±6.5%对31.4%±5.0%,P<0.001)、左心室舒张末期内径[(64.4±8.5)mm对(69.7±8.7)mm,P=0.019]及左心室收缩末期内径[(53.0±11.0)mm对(59.7±10.3)mm,P=0.022]较术前显著改善。结论房室结消融联合LBBP可显著改善房颤伴心衰患者的心脏结构和功能,有望作为房颤心室率控制欠佳患者的有效治疗方法。Objective To investigate the feasibility and efficacy of atrioventricular node ablation combined with left bundle branch pacing(LBBP)in patients with atrial fibrillation(AF)and heart failure(HF).Methods This was a prospective observation study.From January 2021 to December 2022,patients with HF who were treated with atrioventricular node ablation combined with LBBP in Department of Cardiology,Zhongshan Hospital,Fudan University due to uncontrolled ventricular rate by drugs for AF were enrolled in this study.The procedural parameters,pacing parameters and cardiac structure and function were prospectively observed.Results A total of 30 patients were enrolled in this study,including 21 were male with an average age of(64.5±12.8)years old,ventricular rate of(105.2±16.4)bpm.The mean distance between the LBBP lead tip and the ablation target was(22.8±5.3)mm.The paced QRS duration of LBBP was(128.9±10.2)ms,which was significantly shorter than that before operation[(128.9±10.2)ms vs.(145.2±38.2)ms,P=0.030].In terms of pacing parameters,the pacing threshold was(0.9±0.3)V/0.4 ms,the R-wave sensing was(7.7±4.0)mV,and the impedance was(537.5±72.8)Ω.The pacing threshold and R-wave sensing were stable at 6-month follow-up,while the impedance was significantly decreased(P<0.001).No complications such as increased pacing threshold and loss capture were recorded during follow-up.Echocardiographic parameters including left ventricular ejection fractiong(39.4%±6.5%vs.31.4%±5.0%,P<0.001),left ventricular end diastolic diameter[(64.4±8.5)mm vs.(69.7±8.7)mm,P=0.019]and left ventricular end systolic diameter[(53.0±11.0)mm vs.(59.7±10.3)mm,P=0.022]were significantly improved at 6-months follow-up.Conclusion Atrioventricular node ablation combined with LBBP can significantly improve the cardiac structure and function of patients with AF and HF,and is expected to be an effective treatment for uncontrolled ventricular rate in atrial fibrillation.

关 键 词：心房颤动 心力衰竭 房室结消融 左束支起博 可行性 效果 

分 类 号：R541.75[医药卫生—心血管疾病] R541.6[医药卫生—内科学]