传导系统起搏在起搏诱导心肌病患者中应用价值  

Application value of conduction system pacing in patients with pacing-induced cardiomyopathy

作　　者：高阳 彭笑 王城祺 于海波 梁延春 王祖禄 GAO Yang;PENG Xiao;WANG Cheng-qi;YU Hai-bo;LIANG Yan-chun;WANG Zu-lu(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Graduate School of Jinzhou Medical University,Jinzhou 121001,China;Graduate School of Dalian Medical University,Dalian 116044,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016 [2]锦州医科大学研究生院,辽宁锦州121001 [3]大连医科大学研究生院,辽宁大连116044

出　　处：《临床军医杂志》2024年第11期1129-1133,共5页Clinical Journal of Medical Officers

基　　金：国家自然科学基金面上项目(82070308);国家重点研发计划项目(2016YFC0900904)。

摘　　要：目的比较新兴的传导系统起搏(CSP)与传统的双心室起搏(BIVP)在起搏诱导心肌病(PICM)患者中的长期治疗效果和安全性。方法回顾性分析北部战区总医院自2017年1月至2022年12月收治的起搏器升级为心脏再同步化治疗(CRT)起搏器或CRT除颤器(CRT-D)的21例PICM患者的临床资料。根据CRT术式不同将患者分入BIVP组和CSP组。比较两组患者的基线资料、QRS时限(QRSd)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、纽约心脏病协会(NYHA)分级、应答率、超应答率及随访期间不良事件发生率。结果21例患者手术成功率100.0%(21/21),其中,12例患者接受BIVP(BIVP组),9例患者接受CSP(CSP组)。两组患者基线资料比较,差异均无统计学意义(P>0.05)。BIVP组、CSP组患者升级后QRSd短于升级前QRSd,CSP组患者升级后QRSd短于BIVP组,差异有统计学意义(P<0.05)。BIVP组患者升级后6个月LVEDD小于升级后1个月,CSP组患者升级后1个月LVEDD小于升级前且升级后6个月LVEDD小于升级后1个月,差异有统计学意义(P<0.05)。BIVP组、CSP组患者升级后1个月LVEF大于升级前,升级后6个月LVEF大于升级后1个月,差异有统计学意义(P<0.05)。BIVP组、CSP组患者升级后1个月NYHA分级优于升级前,差异有统计学意义(P<0.05)。BIVP组、CSP组患者升级后6个月应答率和超应答率、随访期间不良事件发生率比较,差异均无统计学意义(P>0.05)。结论PICM患者升级为CSP可以取得与BIVP同样的临床效果,长期随访观察安全性较好,可作为CRT升级的替代选择术式。Objective To compare the long-term efficacy and safety of emerging conduction system pacing(CSP)and traditional biventricular pacing(BIVP)in patients with pacing-induced cardiomyopathy(PICM).Methods The clinical data of 21 patients with PICM who were upgraded to cardiac resynchronization treatment(CRT)pacemaker or CRT defibrillator(CRT-D)from January 2017 to December 2022 in the General Hospital of Northern Theater Command were retrospectively analyzed.Patients were divided into BIVP group and CSP group according to different CRT operation types.Baseline data,QRS duration(QRSd),left ventricular end diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF),New York Heart Association(NYHA)grade,response rate,overresponse rate,and incidence of adverse events during follow-up were compared between BIVP group and CSP group.Results The surgical success rate of 21 patients was 100.0%(21/21),of which 12 patients received BIVP(BIVP group)and 9 patients received CSP(CSP group).There was no significant difference in baseline data between the two groups(P>0.05).The QRSd after upgrade in BIVP group and CSP group was shorter than that before upgrade,and the QRSd after upgrade in CSP group was shorter than that in BIVP group,the difference was statistically significant(P<0.05).In the BIVP group,LVEDD at 6 months after upgrade was lower than that at 1 month after upgrade,and the difference was statistically significant(P<0.05).In the CSP group,LVEDD at 1 month after upgrade was lower than that before upgrade,and LVEDD at 6 months after upgrade was lower than that at 1 month after upgrade,the difference was statistically significant(P<0.05).The LVEF of patients in BIVP group and CSP group 1 month after upgrade was greater than that before upgrade,and the LVEF of 6 months after upgrade was greater than that of 1 month after upgrade,the difference was statistically significant(P<0.05).The NYHA grading of patients in BIVP group and CSP group 1 month after upgrade was better than that before upgrade,and the difference was s

关 键 词：传导系统起搏 双心室起搏 起搏诱导心肌病 心脏再同步化治疗 心力衰竭 

分 类 号：R542.2[医药卫生—心血管疾病] R541.6[医药卫生—内科学] R318.11[医药卫生—临床医学]