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    左束支起搏的心室起搏依赖病人安全性评估及短期疗效

    Safety evaluation and short-term efficacy in left bundle branch pacing patients with ventricular pacing dependence

      摘要
    • 摘要:
      目的 观察左束支起搏(LBBP)和右心室间隔起搏(RVSP)的电学、导线参数及位置稳定性，评估其可行性、安全性及同步性。
      方法 回顾分析明确诊断合并左束支阻滞(LBB)的病态窦房结综合征或房室传导阻滞病人37例，行LBBP 20例和RVSP 17例，记录2组临床随访资料及并发症。
      结果 LBBP组心室导线成功植入18例(90%)，RVSP组植入19例(100%)；LBBP组术中起搏阈值、术中起搏感知高于RVSP组(P < 0.05)；术后2组起搏阈值均较术中下降(P < 0.01)。LBBP组术后起搏感知升高，起搏阻抗降低(P < 0.05~P < 0.01)。LBBP组术后QRS时限较术前缩窄(P < 0.05)，RVSP组较术前增宽(P < 0.05)；与RVSP组比较，LBBP组术后QRS时限缩窄(P < 0.05)，左心室激动时间缩短(P < 0.05)。LBBP组术后3个月左心室射血分数(LVEF)及左心室舒张末内径(LVEDD)较术前相比差异均无统计学意义(P>0.05)；RVSP组术后3个月LVEF较术前相比差异无统计学意义(P>0.05)，但LVEDD较术前扩大(P < 0.05)。与RVSP组比较，术后3个月时LBBP组LVEF有所改善，LVEDD缩小(P < 0.05)。LBBP组1例因起搏阈值较高，另1例因右心房较大等原因，均改RVSP成功植入；RVSP组1例术后第2天出现囊袋血肿，经处理后完全吸收。2组术后随访均无囊袋感染、电极脱落、急性心血管及血栓形成事件等发生。
      结论 在心室起搏依赖病人中，LBBP组参数良好且稳定，并发症少，具有可行性及安全性，短期随访LBBP组同步性好。

       

      Abstract:
      Objective To compare the electrical parameters, lead parameters and position stability of left bundle branch pacing (LBBP) and right ventricular septal pacing (RVSP), and to evaluate its feasibility, safety and synchronization.
      Methods A total of 37 patients with SSS or AVB diagnosed were analyzed retrospectively, including 20 patients with LBBP and 17 patients with RVSP.The clinical follow-up data and complications were recorded.
      Results Eighteen cases (90%) of ventricular leads were successfully implanted in the LBBP group, and 19 cases (100%) in the RVSP group.The intraoperative pacing threshold and perception in the LBBP group were higher than those in the RVSP group (P < 0.05).The pacing thresholds of both groups decreased after surgery compared to those during surgery (P < 0.01).In the LBBP group, postoperative pacing perception increased and pacing impedance decreased (P < 0.05 to P < 0.01).The postoperative QRS duration in the LBBP group narrowed compared to before surgery (P < 0.05), while in the RVSP group it widened compared to before surgery (P < 0.05).Compared with the RVSP group, the postoperative QRS duration in the LBBP group narrowed (P < 0.05) and LVAT shortened (P < 0.05).There was no statistically significant difference in LVEF and LVEDD between the LBBP group and the preoperative group at 3 months after surgery (P>0.05).There was no statistically significant difference in LVEF between the RVSP group and preoperative group at 3 months after surgery (P>0.05), but LVEDD expanded compared to preoperative group (P < 0.05).Compared with the RVSP group, LVEF improved and LVEDD decreased in the LBBP group at 3 months after surgery (P < 0.05).One case in LBBP group was successfully implanted with RVSP due to high pacing threshold and another due to large right atrium; one case in RVSP group had bag hematoma on the second day after operation, which was completely absorbed after treatment.There were no bag infection, electrode falling off, acute cardiovascular and thrombotic events in both groups.
      Conclusions In patients with ventricular pacing dependence, LBBP group has stable parameters, less complications, feasibility and safety.LBBP group has good synchronization at short-term follow-up.

       

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