His束起搏应用于心脏再同步化时导线不同极性配置的参数差异

Differentiation study on the different pacing / sensing configurations of His-bundle pacing in CRT-D

目的寻找His束起搏(His-bundle pacing,HBP)用于心脏再同步化起搏和除颤治疗(CRT或CRT-D)更好的起搏和感知配置,从而改善HBP用于CRT-D患者治疗的安全性。方法 16例成功植入His束起搏导线的CRT-D患者在术中和术后即刻、1个月随访时通过改变起搏及感知配置,测量组合双极[HBP tip(Left Ventricular-tip,LVtip)—RV-coil(Right Ventricular-coil)]与传统双极[HBPtip(LV-tip)-—HBP-ring(LV-ring)]时的R波感知振幅、阈值及阻抗并通过公式计算HBP消除CLBBB阈值输出时(脉宽为0.5 ms)的输出能量、导线电流和导线电流密度。结果在术中和术后即刻、1个月随访时,组合双极的感知幅度高于传统双极(P<0.05),阻抗、阈值均低于传统双极(P<0.05);组合双极在术中输出能量低于传统双极;术后即刻和1个月时无差异(P>0.05)。术后1个月随访两种配置的阈值与术中比较保持稳定(P>0.05)。结论当HBP应用在CRT-D治疗时,通过改变不同的HBP(LV)起搏/感知配置发现组合双极比传统双极表现出更高的R波感知振幅,更低的起搏阈值和阻抗,并且不增加能量消耗。

Objective By changing the pacing/sensing configurations in permanent His-bundle pacing（HBP） patients with CRT-D implantation, the electrode thresholds and sensing parameters of HBP could be optimized to improve the stability and safety of HBP. Methods Sixteen patients were implanted CRT-D by permanent HBP mode, the pacing and sensing configurations were changed and R wave sensing amplitude, pacing threshold and impedance parameters were measured in integrated bipolar mode（HBP,LV-tip-RV-coil） and ture bipolar mode（HBP,LV-tip-LV-ring） during, immediately and one month after operation. Pacing energy, current drain and current drain density at the threshold output were calculated by formulae. Results In intra and post-operation the sensing parameters of integrated bipolar configuration was higher than that of the true bipolar configuration（P〈0.05）. The impedance and threshold （ at a pulse width of 0.5 ms） of the integrat- ed bipolar configuration were lower than true bipolar configuration （ P〈0.05 ） during and after implant. The thresholds of two kept stable at 1-month follow-up （P〉0.05）. Energy expenditure of integrated bipolar was lower than that of true bipo- lar configuration during implant. No statistical difference with energy expenditure was found between the two pacing configurations. Conclusions By changing the different pacing/sensing configurations of HBP electrode, integrated bipolar configuration performs better sensing, lower threshold and impendence. And it has also no more energy expenditure than true bipolar configuration.