心室起搏依赖的心力衰竭患者应用希氏束起搏与传统起搏对心脏功能影响的对比研究

Comparison of Effects of His Bundle Pacing and Traditional Pacing on Cardiac Function in Heart Failure Patients With Pacemaker Dependence

目的:探讨心室起搏依赖的心力衰竭患者应用希氏束起搏(HBP)的临床价值。方法:连续入选2017年6月至2018年6月于大连医科大学附属第一医院因心室起搏依赖(心室起搏比例高于40%)而植入永久起搏器且合并心力衰竭的患者132例。HBP成功者44例为HBP组,传统起搏组88例患者。比较两组患者治疗前后的QRS时限、NYHA心功能分级,超声心动图指标及起搏器参数的变化情况;根据基线左心室射血分数(LVEF)再将各组患者分为射血分数保留(HFpEF,LVEF≥40%)患者及射血分数降低(HFrEF,LVEF<40%)患者,再次评价两类患者中HBP和传统起搏的心功能的变化情况。结果:与术前比,HBP组患者术后(末次随访)QRS时限缩短、NYHA心功能分级改善、LVEF升高、左心室舒张末期内径(LVEDD)减小、二尖瓣反流(MR)程度减轻、左心房内径(LAD)缩小(P均<0.05);传统起搏组三尖瓣反流(TR)程度较术前加重(P<0.05),LVEF、LVEDD、MR程度、LAD均较术前无显著改善(P均>0.05)。132例患者中有HFrEF患者47例,其中HBP组20例,传统起搏组27例,HBP组HFrEF患者术后QRS时限缩短、NYHA心功能分级改善、LVEF升高、LVEDD减小、MR和TR程度均减轻、LAD缩小(P均<0.05);传统起搏组HFrEF患者QRS时限延长(P<0.05)。HFpEF患者共85例,其中HBP组24例。HBP组HFpEF患者术后NYHA心功能分级明显改善(P<0.05);而传统起搏组HFpEF患者的LVEF较术前下降、MR和TR程度均加重(P均<0.05)。结论:对于心室起搏依赖的心力衰竭患者,与传统起搏相比,HBP均能够改善患者心功能,这些临床益处在射血分数减低的患者中更为显著。

Objectives:To investigate the efficacy and safety of His bundle pacing(HBP)in heart failure patients with pacemaker dependence.Methods:A total of 132 heart failure patients with pacemaker dependence,hospitalized in the first affiliated hospital of Dalian Medical University from June 2017 to June 2018,were continuously included in this study.Patients were divided into two groups:44 cases with His bundle pacing(HBP group)and 88 cases with traditional pacing(traditional pacing group)respectively.According to baseline ejection fraction,these patients were further divided into two subgroups-HFpEF subgroup with LVEF≥40%,HFrEF subgroup with LVEF<40%respectively.Changes on QRS duration,New York Heart Association(NYHA)functional class,echocardiography parameters and pacemaker parameters were compared between groups.Results:Compared to baseline level,QRS duration,NYHA functional class,LVEF,LVEDD,MR and LAD were all significantly improved in HBP group(all P<0.05).However,in traditional pacing group,LVEF,LVEDD,MR,LAD remained unchanged post-operation(all P>0.05).What was more,the degree of TR increased significantly post operation(P<0.05).As for the two subgroups,there were 47 patients in HFrEF subgroups,including 20 HBP patients and 27 traditional pacing patients.After operation,QRS duration,NYHA functional class,LVEF,LVEDD,MR,TR and LAD were significantly improved compared to baseline level in HBP subgroup(all P<0.05).However,in traditional pacing group,the QRS duration was significantly extended comapred to baseline level.In the HFpEF subgroup,there were 85 patients,including 24 HBP patients and 61 traditional pacing patients.In the HBP subgroup,NYHA functional class was significantly improved compared to baseline level,however,LVEF,MR and TR significantly aggravated post operation compared to baseline level in traditional pacing group(all P<0.05).Conclusions:HBP is effective to improve cardiac function for heart failure patients with both preserved or reduced EF with pacemaker dependence.Patients benefit more from HBP as compared to traditional pacing,especially for heart failure patients with reduced ejection fraction.