右束支旁起搏电极导线植入的初步探讨

Clinical application of para-right bundle branch pacing lead implantation

目的初步探讨右束支旁起搏电极导线的植入方法,并评价其可行性和安全性。方法 50例病态窦房结综合征患者,在右束支电位标测引导下,将右心室起搏电极固定于右束支旁,记录心室起搏电极植入术中尝试位点次数和X线曝光时间。术后1 d、3个月、6个月和1年测试起搏电极参数,同时测量自身、右束支夺获和非夺获心电图QRS波时限进行对比分析。结果 50例患者中41患者成功将右心室起搏电极植入到右束支旁,并能稳定夺获右束支,成功率为82%;尝试位点次数为(5.2±1.5)次,心室电极植入X线曝光时间为(30.0±8.3)min。右心室起搏电极参数测试结果显示:感知和阻抗稳定;右束支夺获阈值明显高于心室起搏阈值(P<0.001);心室起搏阈值和右束支夺获阈值在前6个月轻微增高,6个月以后趋于稳定。右心室起搏(夺获和非夺获右束支)心电图QRS波时限较自身心电图QRS波时限明显增宽(P<0.001);起搏夺获右束支心电图QRS波时限较非夺获右束支心电图QRS波时限缩短(P<0.001)。起搏夺获右束支心脏同步性指标优于非夺获右束(P<0.001);与术前相比,1年随访时,左心室舒张末内径和左心室射血分数无明显变化(P>0.05)。结论右束支旁起搏是一种生理性的心室起搏位点,通过右束支电位标测指导右束支旁起搏电极导线植入安全可行。

Objective To explore the methods for implantation of para-right bundle branch（para-RBB） pacing lead and to evaluate the reliability and feasibility. Methods Fifty patients who need implant pacemakers for suffering from sick sinus syndrome were implanted the right ventricular pacing leads at the region of para-RBB by RBB potential mapping. Clinical data, fluoroscopic exposure time for the para-RBB pacing leads implantation and testing pacing sites of each patient were collected. Pacing leads parameters and QRS width were measured on 1 day, 3 months, 6 months and 1 year after the operation. Results Forty-one patients were successfully implanted the ventricular pacing leads at para-RBB. Mean fluoroscopic exposure time was（30.0±8.3） min, and attempting pacing sites were（5.2±1.5） times. Parameters of sense and impedance were stable. The threshold of capture RBB was higher than pacing ventricle（P〈0.001）. The thresholds of pacing ventricle and capture RBB were increasing slightly during first 6 months, and thereafter were stable. The width of ventricle pacing（capture/non-capture RBB） QRS was longer than intrinsic QRS（P〈0.001）. And the width of capture RBB QRS was shorter than non-capture RBB QRS（P〈0.001）. The cardiac synchronization index of pacing by capture of RBB was better than pacing by non-capture of RBB（P〈0.001）, and there were no differences in the cardiac structure and function between pacing by capture of RBB for 1 year and before operation（P〈0.05）. Conclusion Para-right bundle branch pacing is a new physiological pacing site. By means of mapping the RBB potential, the ventricular pacing leads can be screwed at the region of para-RBB of right ventricular septum. And this application is safe and feasible.