希氏束起搏和传统右室心尖起搏对患者心脏结构及功能的影响

Influence of His-bundle pacing and traditional right ventricular apical pacing on heart structure and function

目的比较希氏束起搏(HBP)与右室心尖起搏(RVAP)在保持左室结构和收缩功能方面的效果。方法选取2012年3月~2015年1月于郑州大学第一附属医院心内科和郑州大学人民医院心内科因房室传导阻滞住院行永久性起搏器植入术共39例患者,其中HBP组成功植入患者15例,RVAP组成功起搏器植入18例,随访观察24个月,比较两组患者的纽约心脏协会(NYHA)心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)变化。结果 HBP组NYHA心功能分级术前、术后无明显变化(P>0.05),RVAP组NYHA心功能分级由术前平均1.4下降至2.5(1.4±0.7 vs.2.5±0.9,P<0.001);HBP组永久性起搏器植入前后LVEF、LVEDD变化无明显变化(P>0.05),RVAP组永久性起搏器植入术后LVEF显著降低[(58.3±6.3)%vs.(50.8±7.5)%,P=0.002],LVEDD显著增加[(43.1±4.6)mm vs.(53.3±7.9)mm,P<0.001]。结论与传统右室心尖起搏相比,希氏束起搏对于收缩功能和左室舒张末内径有优势。

Objective To compare the effects of His-bundle pacing （HBP） and right ventricular apical pacing （RVAP） in keeping right ventricular structure and systolic function. Methods The patients （n=39） undergone implantation of permanent pacemaker due to atrioventricular block （AVB） were chosen from the Department of Cardiology in the First Affiliated Hospital of Zhengzhou University and the Department of Cardiology in People’s Hospital of Zhengzhou University from Mar. 2012 to Jan. 2015. Among all patients, 15 received HBP （HBP group） and 18 received RVAP （RVAP group）. The patients were followed up and observed for 24 months, and changes of NYHA grading, left ventricular ejection fraction （LVEF） and left ventricular end-diastolic inner diameter （LVEDd） were compared. Results NYHA grading had no significant changes before and after implantation in HBP group （P〉0.05）, and NYHA grade was decreased from 1.4 before implantation to 2.5 after implantation in RVAP group （1.4±0.7 vs. 2.5±0.9, P〈0.001）. LVEF and LVEDd had no significant changes before and after implantation in HBP group （P〉0.05）, and LVEF decreased significantly [（58.3±6.3）% vs. （50.8±7.5）%, P=0.002] and LVEDd increased significantly [（43.1±4.6） mm vs. （53.3±7.9） mm, P〈0.001] in RVAP group after implantation. Conclusion Compared with traditional RVAP, HBP has advantages in keeping cardiac systolic function and LVEDd.