希氏束起搏对心脏电、机械同步性及心功能的影响

Influence of His bundle pacing on cardiac electrical,mechanical synchrony and cardiac function

目的通过对缓慢性心律失常患者行希氏束起搏,进一步验证希氏束起搏的安全性和可行性。方法本研究为前瞻性、单中心、临床对照研究,选取2016年1月至2018年6月在张家港市第一人民医院诊断为慢性心律失常(心房颤动伴缓慢心室率患者或病态窦房结综合征)接受心脏起搏器治疗的患者,按照手术方式的不同分为传统右心室起搏组和希氏束起搏组,至少随访6个月,对比两种手术方式的成功率及术后的心脏电和机械同步性、心脏功能、纽约心脏协会(New York Heart Association,NYHA)心功能分级等情况。结果希氏束起搏组最终完成研究36例,传统右心室起搏组完成研究35例。希氏束起搏组在术中、术后6个月的起搏阈值均高于传统右心室起搏组,差异均具有统计学意义(P<0.05)。希氏束起搏组在术中、术后6个月的起搏感知、起搏阻抗与传统右心室起搏组比较,差异均无统计学意义(P>0.05)。希氏束起搏组术后6个月的QRS宽度与术前比较,差异无统计学意义(P>0.05)。希氏束起搏组术后6个月的QRS宽度明显低于传统右心室起搏组,差异有统计学意义(P<0.05)。两组术后6个月的房室间同步性参数LVFT/R-R(%)比较,差异无统计学意义(P>0.05)。希氏束起搏组在心室间机械延迟时间(interventricular mechanical delay,IVMD)及左心室心肌12个节段的收缩期达峰值速度时间的标准差(Ts-SD)均明显低于传统右心室起搏组,差异均有统计学意义(P<0.05)。希氏束起搏组术后6个月左心室射血分数(left ventricular ejection fraction,LVEF)高于传统右心室起搏组术后,差异具有统计学意义(P<0.05)。两组间术前以及术后左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)和NYHA心功能分级比较,差异均无统计学意义(P>0.05)。结论希氏束起搏治疗心房颤动伴缓慢心室率或病态窦房结综合征患者,需要更高的起搏阈值,能够获得更好的心室电及机械同步性,并且对LVEF影响不大。

Objectives To further confirmed the safety and feasibility of His bundle pacing by performing His bundle pacing in patients with chronic bradyarrhythmia. Methods This study was prospective,single-center,clinical controlled. The study selected patients with chronic arrhythmias(atrial fibrillation with slow ventricular rate or sick sinus syndrome)from January 2016 to June 2018 in Zhangjiagang First People′s Hospital. Patients who treated with cardiac pacing were divided into traditional right ventricular pacing group and His bundle pacing group according to different treatment methods. The success rate,postoperative cardiac electricity and mechanical synchrony,New York Heart Association(NYHA)heart function were compared between the two groups after 6 months follow-up. Results Thirtysix patients completed the study in His bundle pacing group and 35 patients were in traditional right ventricular pacing group. The pacing thresholds of His bundle pacing group were higher than those of traditional right ventricular pacing group during the operation and 6 months after operation,and the differences were statistically significant(P<0.05).There were no significant differences in the pacing perception and pacing impedance between His bundle pacing group and traditional right ventricular pacing group during the operation and 6 months after operation(P>0.05). There was no significant difference in the QRS width between 6 months after operation and during the operation in His bundle pacing group(P>0.05). The QRS width at 6 months after operation of His bundle pacing group was significantly lower than that in traditional right ventricular pacing group(P<0.05). There was no significant difference in LVFT/R-R(%)between the two groups 6 months after operation(P>0.05). Interventricular mechanical delay(IVMD)and standard deviation of time to peak(Ts-SD)of left ventricular segments in His bundle pacing group were significantly lower than those in traditional right ventricular pacing group(P<0.05). Left ventricular ejection fraction(LVEF)in His bundle pacing group was significantly higher than that in traditional right ventricular pacing group 6 months after operation(P<0.05). There were no significant differences of left ventricular end-diastolic volume(LVEDV)and NYHA classification between the two groups during the operation and 6 months after operation(P>0.05). Conclusions His bundle pacing in treatment of patients with atrial fibrillation with slow ventricular rate or sick sinus node needs higher pacing threshold,the patients can achieve better ventricular electrical and mechanical synchrony,and there is no obvious influence on LVEF.