左束支起搏与左心室间隔起搏用于心脏再同步治疗的疗效评价  

Efficacy evaluation of left bundle branch pacing and left ventricular septal pacing for cardiac resynchronization therapy

作　　者：黄淑芬 林嘉仪 黄心怡 陈巳楣 李琳琳 葛晓峰 张鹏 于婧 戴翠莲 蔡彬妮 Huang Shufen;Lin Jiayi;Huang Xinyi;Chen Simei;Li Linlin;Ge Xiaofeng;Zhang Peng;Yu Jing;Dai Cuilian;Cai Binni(Division of Cardiology,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen 361004,China;Division of Echocardiography,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen 361004,China;Division of Cardiac Function,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属心血管病医院心内科,厦门361004 [2]厦门大学附属心血管病医院超声部,厦门361004 [3]厦门大学附属心血管病医院心功能科,厦门361004

出　　处：《中华心律失常学杂志》2024年第4期297-305,共9页Chinese Journal of Cardiac Arrhythmias

基　　金：厦门市医疗卫生指导性项目(3502Z20244ZD1234)。

摘　　要：目的比较左束支起搏(LBBP)与左心室间隔起搏(LVSP)在心力衰竭(心衰)合并左束支传导阻滞(LBBB)患者中的临床疗效。方法本研究为前瞻性非随机对照临床研究。连续入选2018年1月25日至2023年10月30日于厦门大学附属心血管病医院心内科确诊心衰合并LBBB符合心脏再同步治疗(CRT)Ⅰ类适应证的患者。按照治疗策略将患者分为LBBP组、LVSP组和双心室起搏(BVP)组,3组患者在出院前、出院后1、3、6个月及之后每年进行随访,比较3组患者的电学与机械同步性以及临床疗效。结果共纳入91例患者,年龄(66.4±9.2)岁,其中男42例(46.2%,42/91)。LBBP组52例,LVSP组12例,BVP组27例,中位随访时间36个月。术后QRS时限缩短率LBBP组与LVSP组相比差异无统计学意义(P=0.055),且均优于BVP组(32.4%±7.1%对20.8%±7.5%,P<0.001;27.8%±7.8%对20.8%±7.5%,P=0.007)。术后6个月左心室射血分数(LVEF)提升值LBBP组高于BVP组,差异具有统计学意义(22.4%±10.5%对14.3%±10.9%,P<0.001),但与LVSP组相比差异无统计学意义(22.4%±10.5%对18.8%±13.0%,P=0.141)。LBBP组CRT超反应率最高(84.6%,44/52),LVSP组与BVP组相当[58.3%(7/12)对44.4%(12/27),P=0.423]。3组患者的全因死亡及心衰再住院的复合终点差异无统计学意义(log-rank P=0.330)。结论LBBP的心脏再同步及临床疗效最优,LVSP电学再同步优于BVP,临床疗效与BVP相当。Objective To compare the clinical outcomes of left bundle branch pacing(LBBP)and left ventricular septal pacing(LVSP)in patients with heart failure complicated with left bundle branch block(LBBB).Methods This was a prospective non-randomized controlled study.Patients with heart failure complicated with LBBB who attempted cardiac resynchronization therapy(CRT)were enrolled from January 25,2018 to October 30,2023,in Xiamen Cardiovascular Hospital.They were divided into LBBP,LVSP and biventricular pacing(BVP)groups.The electrical and mechanical synchronization and clinical efficacy were compared among these three groups.Results A total of 91 patients aged(66.4±9.2)years were selected[42 males(46.2%,42/91)]including 52 in the LBBP group,12 in the LVSP group and 27 in the BVP group.The shortening rate of the QRS duration had no significant difference between LBBP group and LVSP group(P=0.055),but both better than BVP group(32.4%±7.1%vs.20.8%±7.5%,P<0.001;27.8%±7.8%vs.20.8%±7.5%,P=0.007).The increase of left ventricular injection fraction(LVEF)in LBBP group was not significantly different from LVSP group(22.4%±10.5%vs.18.8%±13.0%,P=0.141),but higher than BVP group(22.4%±10.5%vs.14.3%±10.9%,P<0.001).The LBBP group had the highest super-responsiveness rate(84.6%,44/52)of CRT,while the LVSP group and BVP group had no significant difference[58.3%(7/12)vs.44.4%(12/27),P=0.423].There was no significant difference in the primary endpoint events among the three groups(logrank P=0.330).Conclusion LBBP shows the best CRT and clinical efficacy while the electrical resynchronization of LVSP is better than BVP,and the clinical efficacy is comparable to BVP.

关 键 词：心脏再同步疗法 左束支区域起搏 左束支起搏 左心室间隔起搏 双心室起搏 心力衰竭 左束支传导阻滞 

分 类 号：R541[医药卫生—心血管疾病]