三尖瓣环造影下植入心室侧希氏束起搏导线的稳定性和对三尖瓣功能影响的一年随访结果

Evaluation of Lead Stability and Tricuspid Valve Function Post Implantation of Ventricular-sided His-bundle Pacing Lead Guided by Tricuspid Valve Annulus Angiography:Results of 1-year Follow-up

目的:旨在探讨三尖瓣环造影下施行心室侧希氏束起搏(v-HBP)患者1年随访时导线的稳定性和对三尖瓣功能的影响。方法:回顾分析2018年3月至2018年9月在中国医学科学院阜外医院成功行三尖瓣环造影指导下v-HBP导线植入的20例患者的基线和电学参数及超声心动图随访资料,就术中及随访1年的电学参数进行分析,并观察导线对三尖瓣功能的影响。结果:v-HBP中非选择性希氏束起搏比例占70.0%。v-HBP导线植入患者起搏QRS时限显著高于基线QRS时限[(103.2±28.9) ms vs.(91.4±25.8) ms, P=0.025]。术中希氏束夺获阈值为(1.04±0.42)V/1.0 ms,随访1年时,v-HBP希氏束夺获阈值为(1.48±0.85) V/0.4 ms,无一例患者阈值升高> 3.0 V/0.4 ms,R波感知与术中差异无统计学意义[(5.6±2.1) mV vs.(5.2±2.0) mV,P=0.316]。随访1年时超声心动图显示,90%的患者未见三尖瓣反流加重。1年随访期内无导线脱位、感染、导线穿孔等手术相关并发症发生。结论:三尖瓣环造影方法指导下行v-HBP导线植入,1年随访时导线的参数稳定、可靠,不显著影响三尖瓣的功能。

Objectives:This study aimed to assess the feasibility of implanting ventricular-sided His-bundle pacing lead(v-HBP)under the guidance of tricuspid valve annulus(TVA)angiography and assess the tricuspid valve function post v-HBP implantation.Methods:Data including baseline clinical features,pacing parameters,tricuspid valve function and echocardiographic parameters during perioperative period and at 1-year follow-up were analyzed from 20 patients underwent v-HBP by TVA angiography in Fuwai Hospital from March 2018 to September 2019.Results:Non-selective HBP was achieved in 14 patients(70.0%).The paced QRS duration was significantly longer than baseline QRS duration in v-HBP patients([103.2±28.9]ms vs.[91.4±25.8]ms,P=0.025).The His-bundle capture threshold at implantation was(1.04±0.42)V/1.0 ms and remained stable at 1-year follow-up([1.48±0.85]V/0.4 ms).There was no patient presenting with His-bundle capture thresholds>3.0 V/0.4 ms in v-HBP patients.Besides,the R-wave amplitude was(5.2±2.0)mV at implantation and remained stable at 1-year follow-up([5.6±2.1]mV,P=0.316).Compared to baseline,there was no progression of tricuspid regurgitation(TR)for at least 1 grade in 90%v-HBP patients.In addition,no procedure-related complications(such as lead dislodgment,device infection,et al)were observed during the 1-year follow-up.Conclusions:v-HBP guided by TVA angiography is feasible and could be safely performed and tricuspid valve function is not affected by this procedure during the 1-year follow-up.