极简术式指导下左束支起搏术后导线位置的研究  

Position of electrode lead of left bundle branch pacing under guidance of extremely simple technique

作　　者：杨茜 马彦卓 唐丽娜[1] 郭晓萍 陈瑜[1] 宋新星 吴变稳 张哲恺 许梦 齐书英 Yang Xi;Ma Yanzhuo;Tang Lina;Guo Xiaoping;Chen Yu;Song Xinxing;Wu Bianwen;Zhang Zhekai;Xu Meng;Qi Shuying(Department of Cardiology,980th Hospital of Chinese PLA Joint Logistics Support Force,Shijiazhuang 050082,China;不详)

机构地区：[1]中国人民解放军联勤保障部队第九八○医院心内科,石家庄050082

出　　处：《中国循证心血管医学杂志》2024年第12期1449-1451,1456,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省医学科学研究重点课题(20210200)。

摘　　要：目的分析极简术式指导下左束支起搏(LBBP)患者术后电极导线在心脏室间隔的具体位置,为临床中更方便实施LBBP提供指导。方法2021年7月至2023年8月于联勤保障部队第九八○医院行LBBP术的患者32例作为研究对象,所有患者均采用极简术式进行LBBP操作。回顾分析患者的起搏、心电参数和超声心动图指标。结果入选患者32例,其中男性16例(50%),平均年龄(70.6±13.3)岁。病因包括病态窦房结综合征、房室传导阻滞、心房颤动伴长间歇以及心力衰竭伴完全性左束支传导阻滞。术中V6导联R波达峰时间(73.2±7.6)ms,起搏阈值、感知、阻抗参数稳定,术后QRS波时限较术前明显缩短,差异有统计学意义(115.1±25.7 vs.94.1±15.4,P<0.01)。超声心动图可清楚显示电极导线位置,电极植入深度10.0(9.0,11.2)mm,导线头端深度与室间隔厚度比值为1.0(0.9,1.0),导线插入角度为93.0±31.2°,其中,垂直插入室间隔10例,占所有患者的31.3%,电极导线据三尖瓣瓣环距离26.6±7.7 mm。结论极简术式指导下实施LBBP,电极导线插入角度以及导线头端深度与室间隔厚度比值合适,不影响三尖瓣功能,各项参数稳定,可安全地应用于临床。Objective To analyze the position of electrode lead in interventricular septum(IVS)in patients after left bundle branch pacing(LBBP)under guidance of extremely simple technique,and provide guidance for more convenient implementation of LBBP in clinical practice.Methods The patients with planed LBBP(n=32)were chosen from the 980th Hospital of Chinese PLA Joint Logistics Support Force from July 2021 to Aug.2023.All patients were given LBBP under guidance of extremely simple technique.The parameters of pacing and electrocardiogram(ECG),and indexes of echocardiogram were retrospectively analyzed.Results Among 32 patients,there were 16 male patients(50%),and average age was(70.6±13.3).The disease causes in patients included sick sinus syndrome,atrioventricular block(AVB),atrial fibrillation(AF)with long intervals,and heart failure(HF)with complete left bundle branch block(LBBB).The time to peak of R wave in lead V6 was(73.2±7.6)ms.The pacing threshold,perception and impedance parameters were stable,and postoperative QRS duration was significantly shorter than that before LBBP(115.1±25.7 vs.94.1±15.4,P<0.01).The position of electrode lead was clearly displayed by echocardiography,with an implantation depth of 10.0(9.0,11.2)mm,and ratio of lead tip depth to IVS thickness was 1.0(0.9,1.0)mm,and insertion angle of electrode lead was(93.0±31.2).There were 10 patients with vertical insertion into IVS,accounting for 31.3%of all patients.The distance between electrode lead and tricuspid annulus was(26.6±7.7)mm.Conclusion In LBBP under guidance of extremely simple technique,insertion angle of electrode lead and ratio of lead tip depth to IVS thickness are appropriate.LBBP under guidance of extremely simple technique is not affect tricuspid function with stable parameters and can be safely applied in clinical practice.

关 键 词：超声心动图 左束支起搏 左束支夺获 

分 类 号：R540.45[医药卫生—心血管疾病]