左束支区域起搏对房室传导阻滞患者近期疗效及安全性的评估
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摘要
目的评估左束支区域起搏对房室传导阻滞患者的近期疗效及安全性。方法选取2018年1月1日至6月30日因房室传导阻滞入住心内科并行永久性心脏起搏器植入术患者25例(试验组),术中使用美敦力3830-65 cm电极植入右室流出道中低位间隔部左室面,行左束支区域起搏。术后1周、1个月、3个月行起搏器程控及心电图检查,测定心室电极起搏阈值、阻抗、感知功能,以及测定QRS波宽度等;术后3个月行胸片、心脏彩超检查,了解有无电极移位、室间隔穿孔,初步探讨左束支区域起搏的近期疗效及安全性。同时选取2017年我院房室传导阻滞行右室心尖部起搏的患者25例进行对照,比较两组患者上述指标是否有差异。结果两组患者术后各时间段的阻抗均较术中有所下降;同一时间段,试验组的阻抗低于对照组,QRS波宽度亦明显缩小,差异均有统计学意义(P<0.01)。两组患者的阈值及感知功能差异无统计学意义(P>0.05),均未发现明显起搏器电极脱位、室间隔穿孔。结论左束支区域起搏对房室传导阻滞患者的近期疗效及安全性良好,起搏参数稳定。
Objective To evaluate the short-term efficacy and safety of left bundle branch pacing in the treatment of patients with atrioventricular block. Methods A total of 25 patients(Test Group) with atrioventricular block, admitted to the Department of Cardiology from January 1 to June 31, 2018 and having received permanent pacemaker implantation, were selected for our study. Medtronic 3830-65 cm Lead was implanted into left ventricular region in the median-low septum of right ventricular outflow tract for left bundle branch pacing. Pacemaker programming test and electrocardiography were carried out one week, one month and three months after operation, and the pacing thresholds, impedance, perceptive function and the QRS duration were measured. At the meantime, chest X-ray and echocardiography were conducted three months after operation to judge whether there is ventricular lead dislodgment and ventricular septal perforation. In this case, another 25 patients with atrioventricular block receiving right ventricular apical pacing in 2017 were chosen as control. Results There were no significant difference in pacing thresholds and sensing parameter among different time or between two groups(P>0.05). The impedance in both groups decreased after operation compared with that during the operation(P<0.01), and the Test Group had the impedance lower than the Control Group and had the QRS duration significantly reduced compared with the Control Group, and the difference was statistically significant(P<0.01). Furthermore, there was no ventricular lead dislodgment and ventricular septal perforation identified in all patients. Conclusion Left bundle branch pacing is effective and safe in short term for atrioventricular block patients, and the pacing parameter is stable.
Objective To evaluate the short-term efficacy and safety of left bundle branch pacing in the treatment of patients with atrioventricular block. Methods A total of 25 patients(Test Group) with atrioventricular block, admitted to the Department of Cardiology from January 1 to June 31, 2018 and having received permanent pacemaker implantation, were selected for our study. Medtronic 3830-65 cm Lead was implanted into left ventricular region in the median-low septum of right ventricular outflow tract for left bundle branch pacing. Pacemaker programming test and electrocardiography were carried out one week, one month and three months after operation, and the pacing thresholds, impedance, perceptive function and the QRS duration were measured. At the meantime, chest X-ray and echocardiography were conducted three months after operation to judge whether there is ventricular lead dislodgment and ventricular septal perforation. In this case, another 25 patients with atrioventricular block receiving right ventricular apical pacing in 2017 were chosen as control. Results There were no significant difference in pacing thresholds and sensing parameter among different time or between two groups(P>0.05). The impedance in both groups decreased after operation compared with that during the operation(P<0.01), and the Test Group had the impedance lower than the Control Group and had the QRS duration significantly reduced compared with the Control Group, and the difference was statistically significant(P<0.01). Furthermore, there was no ventricular lead dislodgment and ventricular septal perforation identified in all patients. Conclusion Left bundle branch pacing is effective and safe in short term for atrioventricular block patients, and the pacing parameter is stable.
引文
[1]HUANG W,SU L,WU S,et al.Benefits of permanent his bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction[J].JAm Heart Assoc,2017,6(4):1-11.
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[3]中国全科医学编辑部.2008年ACC/AHA/HRS心脏起搏器植入指南[J].中国全科医学,2009,12(1):120-121.
[4]王娜,梁延春,于海波,等.希氏束起搏在需要高比例心室起搏的窄QRS波群患者中应用探讨[J].中国心脏起搏与心电生理杂志,2017,31(5):401-407.
[5]宿燕岗,李勇,葛均波.应用最细电极导线3830行右室间隔起搏一例[J].中国心脏起搏与心电生理杂志,2011,25(5):461-462.
[6]赵辉,王波,王莹惠,等.主动固定电极3830与传统主动电极的比较研究[J].心脏杂志,2017,29(2):176-179.
[7]陆叶,殷泉忠,张华,等.3830主动电极在右室间隔不同部位起搏的临床观察[J].中国心脏起搏与心电生理杂志,2013,27(4):321-323.
[8]张涛,商丽华,黄立纲,等.3830电极在右心室中位间隔起搏的临床观察[J].中华临床医师杂志,2015,9(23):4321-4324.
[9]张新才,邱立彬.应用3830起搏电极室间隔起搏对左心室功能的影响[J].中华老年心脑血管病杂志,2015,17(6):649-650.
[10]HUANG W,SU L,WU S,et al.A novel pacing strategy with low and stable output:pacing the left bundle branch immediately beyond the conduction block[J].Can J Cardiol,2017,33(12):1736-1746.
[2]VIJAYARAMAN P,DANDAMUDI G,ZANON F,et al.Permanent his bundle pacing:recommendations from a multicenter his bundle pacing collaborative working group for standardization of definitions,implant measurements,and follow-up[J].Heart Rhythm,2018,15(3):460-468.
[3]中国全科医学编辑部.2008年ACC/AHA/HRS心脏起搏器植入指南[J].中国全科医学,2009,12(1):120-121.
[4]王娜,梁延春,于海波,等.希氏束起搏在需要高比例心室起搏的窄QRS波群患者中应用探讨[J].中国心脏起搏与心电生理杂志,2017,31(5):401-407.
[5]宿燕岗,李勇,葛均波.应用最细电极导线3830行右室间隔起搏一例[J].中国心脏起搏与心电生理杂志,2011,25(5):461-462.
[6]赵辉,王波,王莹惠,等.主动固定电极3830与传统主动电极的比较研究[J].心脏杂志,2017,29(2):176-179.
[7]陆叶,殷泉忠,张华,等.3830主动电极在右室间隔不同部位起搏的临床观察[J].中国心脏起搏与心电生理杂志,2013,27(4):321-323.
[8]张涛,商丽华,黄立纲,等.3830电极在右心室中位间隔起搏的临床观察[J].中华临床医师杂志,2015,9(23):4321-4324.
[9]张新才,邱立彬.应用3830起搏电极室间隔起搏对左心室功能的影响[J].中华老年心脑血管病杂志,2015,17(6):649-650.
[10]HUANG W,SU L,WU S,et al.A novel pacing strategy with low and stable output:pacing the left bundle branch immediately beyond the conduction block[J].Can J Cardiol,2017,33(12):1736-1746.