希浦系统不同部位起搏的临床应用初步经验
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摘要
目的:观察希氏束起搏(His bundle pacing,HBP)和左束支区域起搏(left bundle branch pacing,LBBP)的可行性和安全性。方法:选取2017年5月—2018年11月具有起搏器植入适应证的患者59例,其中19例行HBP,20例行LBBP,20例行传统右室间隔部起搏(right ventricular septum pacing,RVSP)。根据记录术中心腔内电图和起搏的体表心电图特征,分别定义HBP和LBBP;观察LBBP组和HBP组的起搏参数,包括阈值、R波感知、阻抗,评价LBBP和HBP的可行性和安全性,比较3组起搏的QRS波时限。结果:HBP、LBBP和RVSP的手术成功率分别为79%、95%和100%。术后随访3个月,3组的起搏参数包括阈值、R波感知、阻抗稳定;LBBP组R波感知较HBP组高[(17.01±5.81)mV vs.(4.12±3.86)mV,P<0.05];阈值较HBP组低[(0.66±0.17)V vs.(1.49±0.75)V,P<0.05];HBP、LBBP与RVSP组起搏的QRS波时限分别为(107.18±9.97)ms、(107.77±13.46)ms和(168.00±8.42)ms,HBP和LBBP组的起搏QRS时限明显短于RVSP组(P<0.05);随访期间未发现导线阈值升高、移位或脱位现象。结论:初步证实了希浦系统起搏的可行性、安全性;LBBP与HBP相比,R波感知、阈值更佳,手术成功率更高;与传统右室起搏相比,希浦系统起搏能维持更生理性的心脏电同步性。
Objective:This study aims to explore the feasibility and safety of his bundle pacing(HBP)and left bundle branch pacing(LBBP). Methods:Fifty-nine patients with cardiac pacing were enrolled in the study between May 2017 to Nov. 2018. HBP were performed in group of 19 patients. LBBP were performed in that of 20. Additionally,another 20 patients received right ventricular septum pacing(RVSP). The successful HBP and LBBP were defined by the characteristic intra-electrocardiograph and paced surface QRS morphology,respectively. The feasibility and the short-term safety of the LBBP's and HBP's approach were evaluated. The pace QRS duration was compared among three groups. Results:The successful implanting rates of three different approaches were 79% in HBP group,95% in LBBP group and 100% in RVSP group. The pacing parameters of 3 groups were stable during 3-month follow up.The sensitivity of R wave and pacing threshold in LBBP group seems better than those in HBP group. The pace QRS duration was similar between HBP and LBBP groups;however,the paced QRS duration in RVSP group was significantly broader than those in HBP and LBBP group. Neither complication occurred during this procedure nor in those of follow-up. Conclusion:HBP and LBBP appear to be safe and feasible. LBBP demonstrated with a better sensitivity of R wave and threshold than HBP. Compared to RVSP,HBP and LBBP could maintain better cardiac synchrony.
Objective:This study aims to explore the feasibility and safety of his bundle pacing(HBP)and left bundle branch pacing(LBBP). Methods:Fifty-nine patients with cardiac pacing were enrolled in the study between May 2017 to Nov. 2018. HBP were performed in group of 19 patients. LBBP were performed in that of 20. Additionally,another 20 patients received right ventricular septum pacing(RVSP). The successful HBP and LBBP were defined by the characteristic intra-electrocardiograph and paced surface QRS morphology,respectively. The feasibility and the short-term safety of the LBBP's and HBP's approach were evaluated. The pace QRS duration was compared among three groups. Results:The successful implanting rates of three different approaches were 79% in HBP group,95% in LBBP group and 100% in RVSP group. The pacing parameters of 3 groups were stable during 3-month follow up.The sensitivity of R wave and pacing threshold in LBBP group seems better than those in HBP group. The pace QRS duration was similar between HBP and LBBP groups;however,the paced QRS duration in RVSP group was significantly broader than those in HBP and LBBP group. Neither complication occurred during this procedure nor in those of follow-up. Conclusion:HBP and LBBP appear to be safe and feasible. LBBP demonstrated with a better sensitivity of R wave and threshold than HBP. Compared to RVSP,HBP and LBBP could maintain better cardiac synchrony.
引文
[1]白慧,任晓庆,王方正,等.希氏束和希氏束旁的研究进展[J].中华心律失常学杂志,2016,20(2):172-174
[2] Zografos TA,Siontis KC,Jastrzebski M,et al. Apical vs.non-apical right ventricular pacing in cardiac resynchronization therapy:a meta-analysis[J]. Europace,2015,17(8):1259-1266
[3] Seo Y,Ishizu T,Kawamura R,et al. Three-dimensional propagation imaging of left ventricular activation by speckle-tracking echocardiography to predict responses to cardiac resynchronization therapy[J].J Am Soc Echocardiogr,2015,28(5):606-614
[4] Deshmukh P,Casavant DA,Romanyshyn M,et al. Permanent,direct His-bundle pacing:a novel approach to cardiac pacing in patients with normal His-Purkinje activation[J]. Circulation,2000,101(8):869-877
[5]吴高俊,苏蓝,方丹红,等.永久希氏束起搏临床应用[J].中华心律失常杂志,2012,16(4):302-306
[6] Sharma PS,Dandamudi G,Naperkowski A,et al. Permanent His-bundle pacing is feasible,safe,and superior to right ventricular pacing in routine clinical practice[J].Heart Rhythm,2015,12(2):305-312
[7] Tung S,Lemaitre J. His bundle pacing:In pursuit of the“sweet spot”[J]. Pacing Clin Electrophysiol,2015,38(5):537-539
[8] 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):1376.e1-1376.e3
[9] Chen K,Li Y,Dai Y,et al. Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy[J]. Europace,2019,21(4):673-680
[10] 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]. J Am Heart Assoc,2017,6(4):e005309
[11] CantùF,De Filippo P,Cardano P,et al. Validationg of criteria for selective His bundle and para hisian permanent pacing[J]. Pacing Clin Electrophysiol,2006,29(12):1326-1333
[12] Kronborg MB,Mortensen PT,Gerdes JC,et al. His and para-His pacing in AV block:feasibility and electrocardiographic findings[J]. J Interv Card Electrophysiol,2011,31(3):255-262
[13] Anderson RH,Boyett MR,Dobrzynski H,et al. The anatomy of the conduction system:implications for the clinical cardiologist[J]. J Cardiovasc Translat Res,2013,6(2):187-196
[14]杨曼,郑明奇,吉立双,等.间隔部房室交界区解剖[J].中国误诊学志,2018,13(8):361-367
[15] Pang BJ,Kumar S,Tacey MA,et al. Capturing the HisPurkinje system is not possible from conventional right ventricular apical and nonapical pacing sites[J]. Pacing Clin Electrophysiol,2014,37(6):724-730
[16] Turak O,Ozcan F,Canpolat U,et al. Relation between QRS duration and atrial synchronicity in patients with systolic heart failure[J]. Echocardiography,2014,31(8):972-979
[17]牛红霞,华伟. QRS波与心脏再同步化治疗疗效的相关性[J].中国心脏起搏与心电生理杂志,2014,28(6):539-541
[18]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
[19] Lustgarten DL,Crespo EM,Arkhipova-Jenkins I,et al.His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients:A crossover design comparison[J]. Heart Rhythm,2015,12(7):1548-1557
[2] Zografos TA,Siontis KC,Jastrzebski M,et al. Apical vs.non-apical right ventricular pacing in cardiac resynchronization therapy:a meta-analysis[J]. Europace,2015,17(8):1259-1266
[3] Seo Y,Ishizu T,Kawamura R,et al. Three-dimensional propagation imaging of left ventricular activation by speckle-tracking echocardiography to predict responses to cardiac resynchronization therapy[J].J Am Soc Echocardiogr,2015,28(5):606-614
[4] Deshmukh P,Casavant DA,Romanyshyn M,et al. Permanent,direct His-bundle pacing:a novel approach to cardiac pacing in patients with normal His-Purkinje activation[J]. Circulation,2000,101(8):869-877
[5]吴高俊,苏蓝,方丹红,等.永久希氏束起搏临床应用[J].中华心律失常杂志,2012,16(4):302-306
[6] Sharma PS,Dandamudi G,Naperkowski A,et al. Permanent His-bundle pacing is feasible,safe,and superior to right ventricular pacing in routine clinical practice[J].Heart Rhythm,2015,12(2):305-312
[7] Tung S,Lemaitre J. His bundle pacing:In pursuit of the“sweet spot”[J]. Pacing Clin Electrophysiol,2015,38(5):537-539
[8] 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):1376.e1-1376.e3
[9] Chen K,Li Y,Dai Y,et al. Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy[J]. Europace,2019,21(4):673-680
[10] 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]. J Am Heart Assoc,2017,6(4):e005309
[11] CantùF,De Filippo P,Cardano P,et al. Validationg of criteria for selective His bundle and para hisian permanent pacing[J]. Pacing Clin Electrophysiol,2006,29(12):1326-1333
[12] Kronborg MB,Mortensen PT,Gerdes JC,et al. His and para-His pacing in AV block:feasibility and electrocardiographic findings[J]. J Interv Card Electrophysiol,2011,31(3):255-262
[13] Anderson RH,Boyett MR,Dobrzynski H,et al. The anatomy of the conduction system:implications for the clinical cardiologist[J]. J Cardiovasc Translat Res,2013,6(2):187-196
[14]杨曼,郑明奇,吉立双,等.间隔部房室交界区解剖[J].中国误诊学志,2018,13(8):361-367
[15] Pang BJ,Kumar S,Tacey MA,et al. Capturing the HisPurkinje system is not possible from conventional right ventricular apical and nonapical pacing sites[J]. Pacing Clin Electrophysiol,2014,37(6):724-730
[16] Turak O,Ozcan F,Canpolat U,et al. Relation between QRS duration and atrial synchronicity in patients with systolic heart failure[J]. Echocardiography,2014,31(8):972-979
[17]牛红霞,华伟. QRS波与心脏再同步化治疗疗效的相关性[J].中国心脏起搏与心电生理杂志,2014,28(6):539-541
[18]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
[19] Lustgarten DL,Crespo EM,Arkhipova-Jenkins I,et al.His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients:A crossover design comparison[J]. Heart Rhythm,2015,12(7):1548-1557