希氏束起搏电极远场心房感知特点的研究

The characteristics of far-field atrial sensing in His bundle pacing lead

目的探讨希氏束起搏电极远场心房感知大小及其与心室感知和心房颤动(下称房颤)的关系。方法选择2016年1月至2017年5月温州医科大学附属第一医院常规随访行不同极性远场心房感知及心室感知测定的患者109例,其中房颤84例。测量希氏束电极上心房和心室振幅大小。分析远场心房误感知发生率,探讨其与心室感知大小及是否存在房颤的关系。结果希氏束电极在双极及单极状态下远场心房感知振幅分别为(0.30±0.24)mV、(0.37±0.21)mV。75例同时具有单、双极感知患者中,64.0%的患者单极远场心房感知大于0.20 mV,高于双极的45.3%(P<0.01)。双极心室感知与远场心房感知振幅比(V/A)与心室感知大小呈正相关(r=0.771,P<0.01)。房颤患者的远场感知明显小于非房颤患者[(0.25±0.16)mV比(0.48±0.36)mV],差异有统计学意义(P<0.01)。结论希氏束起搏双极设置有利于减少远场心房误感知,房颤患者远场心房误感知较低。

Objective To assess far-field atrial sensing in His bundle pacing(HBP)lead and its association with ventricular sensing and atrial fibrillation(AF).Methods 109 patients underwent testing of atrial far-field sensing and ventricular sensing in both unipolar and bipolar configuration from January 2016 to May 2017 in the First Affiliated Hospital of Wenzhou Medical University were enrolled.Of them,87 cases had AF.Atrial and ventricular amplitude in HBP lead was measured.The incidence of far-field atrial oversensing and its association with ventricular sensing and AF were analyzed.Results The far-field atrial amplitude was(0.30±0.24)mV and(0.37±0.21)mV,respectively,in bipolar and unipolar configuration.In 75 patients with both atrial and ventricular sensing,the percentage of far-field atrial amplitude>0.20 mV was 64%in unipolar configuration,significantly higher than 45.3%in bipolar configuration(P<0.01).The ratio of ventricular amplitude in bipolar configuration to far-field atrial amplitude was positively related to ventricular amplitude(r=0.771,P<0.01).The far-field atrial amplitude was significantly lower in patients with AF than without AF[(0.25±0.16)mV vs.(0.48±0.36)mV(P<0.01)].Conclusion Bipolar setting is benefit of reducing far-field atrial oversensing during HBP.Far-field atrial oversensing is relatively infrequent in patents with AF.