希氏束起搏的安全性和可行性研究

Study on the safety and feasibility of His bundle pacing

目的通过对希氏束起搏及心尖部起搏的心电生理学和血流动力学效应比较,探讨希氏束起搏的安全性和可行性。方法对43例有起搏植入适应症的患者,采用无创胸电生物阻抗法连续血液动力学监护系统及超声心动图对心输出量(CO),每搏输出量(SV),心脏指数(CI),射血分数(EF),起搏阈值,R波幅度,电极导线阻抗以及各部位起搏前后QRS时限进行测试比较。结果希氏束起搏与右心室心尖部起搏阈值,R波幅度,电极导线阻抗比较无显著性差异(P>0.05)。右心室心尖部起搏时QRS时限长,心输出量(CO)、每搏输出量(SV)、心脏指数(CI)和射血分数(EF)比希氏束起搏低,右心室心尖部起搏时对心脏功能影响大(P<0.05)。结论希氏束起搏比心尖部起搏具有更好的血流动力学效应,接近于自身窦性心律,希氏束起搏是安全、可行的。

Objective To explore the safety and feasibility of His bundle pacing.Methods The pacing threshold,amplitude of R wave,electrode cable impedance,cardiac output,stroke volume,cardiac index,ejection fraction and QRS wave duration of 43 patients with indication for permanent VVI pacing were observed.Several pacing places were tested and compared after the one month.Results There were no significant differences in pacing threshold,amplitude of wave R,electrode cable impedance between right ventricle apex and His bundle pacing（P〈0.05）.The QRS duration,cardiac output,stroke volume,cardiac index,ejection fraction were significantly difference between right ventricle apex and His bundle pacing（P〈0.05）.Conclusion Cardiac electrophysiology and hemodynamics of the permanent pacing position of His bundle are more beneficial than that of the pacing position of right ventricle apex.