左束支起搏在心脏再同步治疗的初步应用经验

Primary clinical experience of left bundle branch pacing in CRT

目的:评价左束支起搏(LBBP)在需要行心脏再同步治疗心力衰竭(心衰)中的应用价值。方法:入选2017-12-2019-11有心脏再同步起搏器(CRT)植入适应证的患者12例,因CS电极植入失败或有备用插孔,所有患者均植入左束支电极。术后心室为单纯LBBP起搏。观察植入时LBBP和RV起搏参数,包括阈值、阻抗、感知,评价LBBP和RV的起搏参数;比较植入时LBBP、自身QRS、RV和BIV起搏的QRS时限。术前、术后检查心脏彩超,观察左室舒张末内径(LVEDD)和左室射血分数(LVEF)变化。结果:植入时LBBP与RV的起搏参数相当,LBBP起搏的QRS时限明显短于BIV(P<0.05);LBBP纠正6例患者完全性左束传导阻滞。LVEDD较术前明显缩小[(6.1±0.26)cm∶(5.7±0.25)cm,P<0.05]。LVEF较术前明显提高[(38±3.0)%∶(44±2.8)%,P<0.05],随访未发现不良反应。结论:LBBP安全有效,可以改善心衰患者心功能,为传统CRT治疗无效患者提供新的选择。

Objective:This study aims to explore the efficacy of left bundle branch pacing(LBBP)in cardiac resynchronization therapy(CRT).Method:Twelve patients with CRT pacing were enrolled in the study from May 2018to August 2019.All patients underwent LBBP.Pacing parameters,LVEDD and LVEF were assessed at implantation and 3-month follow-up.The pace QRS duration was compared among LBBP,Biv,RV and intrinsic QRS.Result:Pacing parameters(thresholds,impedance,sensor)were similar between LBBP and RV at implantation.Pacing thresholds remained low and stable at 3-month follow-up.The pace QRS duration in LBBP was significantly narrower than that in Biv.Left bundle branch block in six patients were corrected by LBBP.Left ventricular end-diastolic diameter(LVEDD)was significantly reduced and left ventricular ejection fraction(LVEF)was significantly increased within 3 months.No adverse event was observed during 3-month follow-up.Conclusion:Left bundle branch pacing produces narrow QRS duration and improves heart function,which may be a new pacing strategy for patients who are failed in conventional CRT.