超声心动图定位评价左束支区域起搏电极的可行性研究

Value of echocardiography in evaluating pacing lead position after left bundle branch area pacing

目的总结左束支区域起搏(LBBP)电极的超声心动图表现,探讨电极距三尖瓣隔瓣距离(DTV-L)等指标定量评价起搏电极位置的可行性。方法选取2019年3月至12月在首都医科大学附属北京安贞医院行LBBP术的患者49例,其中男性28例,女性21例,年龄19~89岁,平均年龄(65±16)岁。总结患者的超声心动图表现,根据术中起搏电极的植入位置将病例分为高位间隔组(14例)、中位间隔组(17例)和低位间隔组(18例),采用单因素方差分析比较3组病例电极植入位置(DTV-L)及植入深度的差异。结果所有病例均可在超声心动图中显示电极尖端位置,LBBP电极植入室间隔的深度平均为(8.13±2.10)mm,距左心室面距离平均为(2.25±1.79)mm,不同组间电极植入深度及距左心室面距离比较,差异均无统计学意义(P均>0.05)。3组病例DTV-L结果比较,高位间隔组电极明显小于中位间隔组[(10.79±6.62)mm vs(17.59±5.23)mm,P<0.05],中位间隔组则明显小于低位间隔组[(17.59±5.23)mm vs(32.83±8.99)mm,P<0.001],3组间比较,差异有统计学意义(F=40.273,P<0.001)。结论超声心动图可用于LBBP电极的定位评价,DTV-L等参数可作为LBBP电极定位评价的量化指标,为临床提供更有价值的信息。

Objective To summarize the echocardiographic characteristics of pacing electrode in left bundle branch area pacing(LBBP),and to explore the feasibility of using the distance from the base of septal tricuspid leaflet to lead tip(DTV-L)to quantify the pacing electrode location.Methods Forty-nine patients with LBBP were enrolled.The echocardiographic characteristics of pacing electrode were analyzed.According to the position of lead under fluoroscopy,all patients were divided into high-septum(n=14),mid-septum group(n=17),and low-septum groups(n=18).The differences of DTV-L in echocardiography were compared between the three groups.Results The position of the lead tip could be assessed by echocardiography in all patients.The average length of lead in the interventricular septum was(8.13±2.10)mm,and the average distance from the lead tip to the endocardium was(2.25±1.79)mm.There was no significant difference in the above measurements among the three groups.The DTV-L assessed by echocardiography in the high-septum group was significantly less than that of the mid-septum group[(10.79±6.62)mm vs(17.59±5.23)mm,P<0.05],and DTV-L in the mid-septum group was significantly less than that of the low-septum group[(17.59±5.23)mm vs(32.83±8.99)mm,P<0.001].Conclusion Echocardiography can be used to assess the position of pacing lead accurately after LBBP.DTV-L can provide a quantitative parameter in lead position assessment,and provide more information in postoperative evaluation.