缓慢型心房颤动伴心力衰竭希氏束起搏临床应用

Clinical application of His bundle pacing in slow atrial fibrillation with heart failure

目的探讨缓慢型心房颤动伴心力衰竭患者希氏束起搏术后1年的安全性及疗效。方法选取成功行希氏束起搏(HBP)并规律随访满1年的缓慢型心房颤动伴心力衰竭患者28例,随访观察1年,比较术后即刻及随访1年后的起搏参数(阈值、感知、阻抗)、纽约心脏协会(NYHA)心功能分级、脑钠肽(BNP)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)变化。结果28例患者术后阈值、感知、阻抗分别为(1.17±0.35)V、(2.66±1.10)mV、(508±62)Ω,术后1年分别为(1.31±0.45)V、(2.68±1.21)mV、(447±60)Ω,前后差异均无统计学意义(均P>0.05)。术后1年患者临床心功能均明显改善,NYHA心功能分级(2.7±0.7)和BNP结果[(528.6±70.4)ng/L]较术后即刻[1.5±0.8、(336.6±60.6)ng/L]明显改善(均P<0.01)。结论缓慢型心房颤动伴心力衰竭患者中,希氏束起搏安全可行,1年参数稳定,临床心功能改善疗效显著。

Objective To evaluate the safety and efficacy of His bundle pacing in patients with slow atrial fibrillation and heart failure.Methods Twenty eight patients with slow atrial fibrillation and heart failure,including 24 males and 4 females aged 76.0±4.5 years,receiving permanent His bundle pacing from December 2015 to May 2017 were enrolled.The pacing parameters(threshold,perception,impedance),cardiac function classification of New York Heart Association(NYHA),B-type brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF)and left ventricular diastolic terminal internal diameter(LVEDD)were measured and compared immediately after operation and one year after operation.Results The postoperative threshold,perception and impedance were(1.17±0.35)V,(2.66±1.10)mV,(508±62)Ωimmediately after operation,and(1.31±0.45)V,(2.68±1.21)mV,(447±60)Ωone year after operation,respectively(all P>0.05).There was a significant improvement in cardiac function grading(NYHA grading)and heart failure index BNP in one year later(1.5±0.8 vs 2.7±0.7,P<0.01;336.6±60.6 vs 528.6±70.4,P<0.01).Conclusion The His bundle pacing is safe and effective for cardiac function improvement in patients with slow atrial fibrillation and heart failure,and the parameters are stable after one year of follow-up.