左束支区域起搏对心室起搏患者心脏功能、血浆BNP水平及心律失常发生率的影响  

Effects of left bundle branch pacing on cardiac function,plasma BNP level and incidence of arrhythmia in patients with ventricular pacing

作　　者：胡钦 韩卫卫 梁洁 周峰 计承 刘金波 HU Qin;HAN Wei-wei;LIANG Jie;ZHOU Feng;JI Cheng;LIU Jin-bo(Department of Cardiovascular Medicine,Shijiazhuang People’s Hospital,Shijiazhuang 050000,China)

机构地区：[1]石家庄市人民医院心血管内科,河北省石家庄市050000

出　　处：《中国心血管病研究》2024年第6期549-553,共5页Chinese Journal of Cardiovascular Research

基　　金：河北省2020年度医学科研课题计划(20201407)。

摘　　要：目的 探讨左束支区域起搏(LBBP)对心室起搏患者心脏功能、血浆B型脑钠肽(BNP)水平及心律失常发生率的影响。方法 回顾性分析2021年5月至2023年5月就诊于石家庄市人民医院的62例需心室起搏的患者,按心脏起搏电极植入部位不同分为LBBP组(32例)和右心室间隔部起搏(RVSP)组(30例),比较两组心脏功能[左心室射血分数(LVEF)、左心房容积指数(LAVI)、三尖瓣环收缩期位移(TAPSE)、二尖瓣环处舒张早期峰值流速(Ea)、二尖瓣口舒张早期的血流峰值速度(E)与二尖瓣环舒张早期峰值速度(Ea)的比值(E/Ea)]、起搏参数及QRS波时限、血浆BNP和6 min步行试验(6-MWT)和心律失常发生率。结果 术后6个月,RVSP组LVEF、TAPSE相比术前RVSP组和术后6个月LBBP组均降低(P<0.05),术后6个月RVSP组LAVI、E/Ea相比术前RVSP组和术后6个月LBBP组均升高(P<0.05)。术后1周、术后1个月、术后6个月LBBP组和RVSP组起搏参数(阈值、感知、阻抗)比较均无明显差异(P>0.05)。术后1周、术后1个月、术后6个月LBBP组QRS波时限均低于RVSP组(P<0.05)。两组术后心律失常发生率比较差异不明显(P>0.05)。结论 与RVSP相比,LBBP应用于心室起搏患者可有效降低术后血浆BNP水平和QRS波时限,有助于心脏功能的改善。Objective To explore the effects of left bundle branch regional pacing(LBBP)on cardiac function,plasma B-type brain natriuretic peptide(BNP)level and arrhythmia incidence in patients with ventricular pacing.Methods 62 patients requiring ventricular pacing admtted to Shijiazhuang People’s Hospital from May 2021 to May 2023 were included,and were divided into the LBBP group(32 cases)and the right ventricular septal section pacing(RVSP)group(30 cases)according to the implantation sites of cardiac pacing electrodes.The cardiac function[left ventricular ejection fraction(LVEF),left atrial volume index(LAVI),tricuspid annular displacement during systole(TAPSE),early peak diastolic flow rate at the mitral annulus(E peak),E/Ea],pacing parameters and QRS wave time frame,plasma BNP and 6-minute walk test(6-MWT)and the incidence of arrhythmia were compared between the two groups.Results LVEF and TAPSE were lower in the RVSP group compared with the preoperation and the LBBP group at 6 months postoperatively(P<0.05);LAVI and E/Ea were higher in the RVSP group compared with the preoperation and the LBBP group at 6 months postoperatively(P<0.05).There was no significant difference in the comparison of pacing parameters(threshold,perception,impedance)between 2 groups at 1 week,1 month and 6 months postoperatively(P>0.05).The QRS wave time limits were lower in the LBBP group than in the RVSP group at 1 week,1 month and 6 months postoperatively(P<0.05).The difference in the incidence of postoperative arrhythmia between the two groups was not significant(P>0.05).Conclusion Compared with RVSP,LBBP applying to patients with ventricular pacing can effectively reduce the postoperative plasma BNP level and QRS wave time limit,which contributes to the improvement of cardiac function.

关 键 词：心室起搏 左束支区域起搏 心脏功能 血浆B型脑钠肽 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]