希浦系统起搏在缓慢性心律失常中的应用

Application of his-purkinje conduction system pacing in tardy arrhythmia

目的探讨希浦系统起搏在缓慢性心律失常患者中运用的安全性和有效性。方法选择2018年5-8月在本院诊治的19例符合起搏器植入指征的缓慢性心律失常患者作为研究对象。若3830电极标记到希氏束电位并能稳定起搏者行希氏束起搏(His组,希氏束组),若失败,3830电极若能拧过室间隔到达左室内膜下并能稳定起搏,起搏心电图呈右束支图形者行左束支区域起搏(LBBB组,左束支组),若3830电极不能拧过间隔部到达左室内膜面,起搏心电图呈左束支图形者行右室间隔部起搏(RVS组,间隔组)。采用起搏系统分析仪测量植入即刻、3月的起搏阈值、振幅和阻抗等参数,观察起搏电极导线有无移位等并发症。结果本研究中19例患者均成功地植入了永久心脏起搏器,9例完成希氏束(旁)起搏,6例完成左束支(旁)起搏,希浦系统植入成功率78.9%。植入即刻和3个月测试程控参数三组间无统计学差异。截止随访期末未出现心肌穿孔、感染等并发症,无死亡病例,患者预后良好。结论在缓慢性心律失常患者中采用希浦系统起搏是安全的和有效的,术后起搏参数较为稳定。

Objective To investigate the safety and efficacy of his-purkinje conduction system pacing in patients suffered with tardy arrhythmia.Methods From May to August 2018,19 patients with chronic arrhythmia who met the criteria of pacemaker implantation in our department were enrolled as the study subjects.Some patients who could mapped His-beam potential by the 3830 pole and got stable pacing parameters received Kent-His bundle pacing(His group).Under the condition of failed,if the 3830 pole could twist through the ventricular septum and reach endocardium of left ventricular and got stable pacing,and the pacing electrocardiogram present as right bundle branch pattern,the patients received left bundle branch area pacing(LBBB group).In case of could not twist through the ventricular septum and reach endocardium of left ventricular and the pacing electrocardiogram present as left bundle branch pattern,the patients received right ventricular septal pacing(RVS group).Pacing system analyzer was used to measure the changes of pacing threshold,amplitude and impedance parameters immediately after implantation and 3 months after implantation and the pacemaker leads were observed for complications such as displacement.Results In this study,19 patients were successfully implanted with a permanent cardiac pacemaker,9 patients completed permanent his bundle(side)pacing,and 6 patients completed left bundle branch(side)pacing.The success rate of his-purkinje conduction system implant was 78.9%.There was no statistical difference in the test program parameters among the three groups at the immediate implantation and 3-month.Until the end of follow-up,there were no myocardial perforation,infection and other complications,no death cases,and the patients had a good prognosis.Conclusions The use of his-purkinje conduction system pacing in patients with tardy arrhythmia is safe and effective,and pacing parameters are relatively stable.