His束起搏对心脏运动的同步性和心功能的影响

Effect of his bundle pacing of cardiac motion synchrony and cardiac function

目的评价希式束起搏(HBP)及右室间隔部起搏(RVSP)对室壁运动和心功能的影响。方法选择21例HBP组和21例RVSP组患者,观察两组起搏术后7天、1个月、6个月的起搏参数。并把QRS波的宽度作为心室电活动的指标,在定量组织速度成像模式下采集标准心尖四腔、二腔和左室长轴的彩色组织多普勒图像并储存,评价HBP与RVSP时心肌运动的变化,并测定评价心功能的心脏超声指标:量左室舒张末内径,左室收缩末内径,舒张末室间隔厚度,左室后壁厚度,左室舒张末容积,左室收缩末容积(LVESV),每搏输出量(SV),心输出量(CO),左室射血分数(LVEF)。检验指标:N末端B型脑钠肽前体(NT-proBNP)。结果 (1)两组起搏阈值、起搏感知、阻抗无差异,无电极移位、阈值增高。(2)HBP组QRS波时限正常,RVSP组QRS波时限大于HBP起搏时(P<0.001)。(3)两组同一心动周期心肌运动曲线比较:HBP时曲线走势与正常时基本一样;而RVSP时曲线杂乱,各波达峰时间不再一致,心肌运动规律性也明显改变。(4)与RVSP组比较,HBP组左室内,左、右室机械运动的同步性均有改善(P<0.05)。(5)HBP状态下心功能明显改善:LVESV显著减小,SV、CO显著增加(均P<0.001)、LVEF明显改善(P<0.001)、NT-proBNP明显改善(P<0.001)。结论与RVSP比较,HBP有利于保持心肌电活动和机械收缩的同步性,并有助于改善患者心功能。

Objective To evaluate the effects of his bundle pacing （HBP） on the synchrony of cardiac motion and right ventricular septal pacing （RVSP） effects on ventricular wall motion and cardiac function. Methods Twenty- one cases of HBP group and 21 cases of RVSP group were selected. The pacing parameters of two groups were ob- served at 7 days, 1 and 6 months after pacing. The width of QRS wave was used as the index of ventricular electrical activity. The color tissue Doppler images of the standard apical four cavity, two cavity and the long axis of the left ventricle were collected and stored in the quantitative tissue velocity imaging mode. The changes of cardiac muscle movement in HBP and RVSP were evaluated, and the echocardiographic indexes for evaluating the cardiac function were measured： the left ventricular end diastolic diameter, left ventricular end systolic diameter, end diastolic inter- ventricular septum thickness, left ventricular posterior walt thickness, left ventrieular end diastolic volume, left ventricular end systolic volume （LVESV）, stroke volume（SV）, cardiac output （CO） and left ventricular ejection fraction （LVEF）,test index： B sodium brain natrium at N end peptide precursor （NT- proBNP）. Results ① There were no difference in pacing threshold, pacing perception and impedance between the two groups. ②The QRS wave duration was normal in group HBP, and the QRS wave duration in group RVSP was larger than that in HBPgroup （P〈0.OO1）. ③The myocardial motion curves of the two groups were compared with the same cardiac cycle~ HBP curve trend was the same as the normal time basis; while RVSP curves were disorderly and the peak time of each wave was no longer consistent, and the regularity of myocardial motion was also sig- nificantly changed. ④Compared with group RVSP ,the synchronyof left and right ventricular mechanical motion in HBP group were improved （P〈0.05）. ⑤The cardi ac function was significantly improved under HBP： I.VESV significantly decreased, SV, CO increased significantly （P〈0.001）, LVEFweresignificantlyimproved（P〈0.001）. Conclusion Compared wilh RVSP, HBP is benefi- cial to maintain the synchrony of myocardial electrical activity and mechanical contraction, and to improve cardiac function of patients.[Chinese Journal of Cardiac Pacing and Electroph ysiology ,2018,32（4） ：369--374]