希氏束起搏阈值升高的预测因素分析:单中心5年随访结果  

Analysis of predictors of increased His bundle pacing threshold:a 5-year follow-up from a single center

作　　者：折壮川 陈莹 丁宛萱 杨乙珩 王楠[1] 孙伟[1] 李国草[1] 马裴裴[1] 张荣峰[1] 肖宪杰 董颖雪[1] She Zhuangchuan;Chen Ying;Ding Wanxuan;Yang Yiheng;Wang Nan;Sun Wei;Li Guocao;Ma Peipei;Zhang Rongfeng;Xiao Xianjie;Dong Yingxue(The Second Department of Arrhythmia Department,The First Affiliated Hospital of Dalian Medical University,Dalian 116021,China)

机构地区：[1]大连医科大学附属第一医院心律失常二科,大连116000

出　　处：《中华心脏与心律电子杂志》2024年第3期149-154,共6页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

基　　金：大连市科技创新基金(2020JJ26SN055)

摘　　要：目的探究希氏束起搏(HBP)随访期间阈值变化情况和阈值升高的预测因素。方法连续纳入2017年7月至2018年10月在大连医科大学附属第一医院心律失常二科房室传导阻滞且有心室起搏适应证的患者或已植入起搏器出现心功能恶化伴高心室起搏需行HBP升级的患者,行HBP治疗。收集患者人口统计学、合并疾病、起搏器植入适应证、超声心动图参数和心电图参数资料。分别于术后1、3、6、12个月随访,1年后每6个月随访1次,随访时记录起搏阈值、R波感知和导线阻抗等。对年龄、性别、合并疾病、术中损伤电流、基线阈值、损伤电流、右心室感知、左心室射血分数等进行Logistic回归分析,评价患者HBP阈值升高的预测因素。患者术后阈值增高定义为术后随访任何时间起搏阈值较基线阈值升高>1.0 V且绝对值>2.5 V/0.4 ms。结果成功行HBP患者45例,中位随访60(57,63)个月,37(82.22%,37/45)例患者希氏束夺获阈值保持稳定,8(17.78%,8/45)例患者的希氏束夺获阈值增高。Logistic回归分析发现术中出现损伤电流的患者起搏阈值有稳定的倾向[OR=0.121,95%CI 0.014~1.088,P=0.059],心室感知对HBP远期阈值稳定性具有统计学意义(OR=0.635,95%CI 0.436~0.923,P=0.017)。结论部分HBP患者远期可出现起搏阈值升高,术中出现损伤电流及R波振幅较高的患者起搏阈值更易保持稳定。Objective To identify the changes in the threshold during the follow-up period of His bundle pacing(HBP)and to explore the predictors of threshold elevation.Methods Patients with atrioventricular block and ventricular pacing indications or patients with cardiac function deterioration with high ventricular pacing compared to HBP escalation in the Second Department of Arrhythmia in the First Affiliated Hospital of Dalian Medical University from July 2017 to October 2018 were continuously enrolled.The data of patient demographics,comorbidities,indications for pacemaker implantation,echocardiography parameters and electrocardiogram parameters were collected,and follow-up was conducted once at the first,third,sixth,and tweilveth months after the implantation,and every 6 months after 1 year.The pacing threshold,R-wave perception and wire impedance,etc.were recorded during the follow-up.Logistic regression analysis was performed on age,gender,comorbidities,intraoperative injury current,baseline threshold,injury current,right ventricular perception,left ventricular ejection fraction,etc.to evaluate the predictors of HBP threshold elevation.Postoperative threshold elevation was defined as an increase in the pacing threshold of>1.0 V from the baseline threshold at postoperative follow-up and reaching more than 2.5 V/0.4 ms.Results After 60(57,63)months of follow-up,37(82.22%,37/45)patients with HBP remained stable and 8(17.78%,8/45)patients increased the threshold for His bundle capture.Logistic regression analysis showed that the pacing threshold of patients with intraoperative injury current tended to be stable[odds ratio(OR)=0.121,95%confidence imterval(CI)0.014-1.088,P=0.059],and ventricular perception was statistically significant for the stability of the long-term threshold of HBP(OR=0.635,95%CI 0.436-0.923,P=0.017).Conclusion Some patients with HBP may have an elevated pacing threshold in the long term,and the pacing threshold is more likely to be stable in patients with high intraoperative injury current and R-wave

关 键 词：希氏束起搏 阈值 预测因素 损伤电流 感知 

分 类 号：R541.7[医药卫生—心血管疾病]