不同阻滞位置房室传导阻滞患者左束支区域起搏的可行性探讨

Feasibility of left bundle branch area pacing in patients with atrioventricular block at different blocking sites

目的探讨不同阻滞位置的房室传导阻滞患者行左束支区域起搏的可行性。方法32例因房室传导阻滞住院行起搏器植入患者,行心脏电生理检查,房室结阻滞11例、希蒲传导系统阻滞21例;根据心室电极植入位置分为两组,18例为右心室间隔部起搏(RVSP组),14例为左束支区域起搏(LBBaP组),比较两组术后QRS宽度、心室电极感知、心室起搏阈值、心室电极阻抗、手术时间和X线曝光时间。结果14例患者成功行LBBaP,成功率93.3%(14/15)。LBBaP组术后QRS波群宽度较RVSP组明显缩短,存在明显统计学差异[(133.18±16.90)ms vs.(106.36±15.18)ms,P<0.001]。两组在电极感知、起搏阈值及电极阻抗方面无统计学差异;但是LBBaP组手术时间及X线曝光时间明显长于RVSP组,且存在明显统计学差异(P<0.01)。房室结阻滞患者和希蒲传导系统阻滞患者行左束支区域起搏术后QRS波群宽度明显缩短,但二者间无统计学差异[(106.00±7.58)ms vs.(108.90±5.34)ms,P=0.757]。在LBBaP组中有8例合并左束支或右束支传导阻滞,7例束支阻滞得到校正,其中5例为完全性右束支阻滞,给予双极起搏,术后QRS波宽度明显变窄。结论左束支区域起搏对于房室结阻滞和希蒲系传导系统阻滞导致的房室传导阻滞患者有较高成功率,即刻效果及安全性良好,起搏参数稳定;相对于右心室间隔部起搏,左束支区域起搏可明显缩短QRS波宽度、保持心室同步性,尤其对于合并束支传导阻滞的患者。

Objective To discuss the feasibility of left bundle branch area pacing(LBBaP)in patients with atrioventricular block(AVB)at different blocking sites.Methods The patients(n=32)were admitted due to AVB and received pacemaker implantation and cardiac electrophysiological examinations.There were 11 patients with atrioventricular node block and 21 with His-Purkinje system block.The patients were divided,according to implantation locations of ventricular electrodes,into group of right ventricular septal pacing(RVSP group,n=18)and LBBaP group(n=14).The width of QRS,ventricular electrode perception,ventricular pacing threshold,ventricular electrode impedance,operation duration and X-ray exposure time were compared between 2 groups.Results LBBaP was successfully performed in 14 patients and success rate was 93.3%(14/15).The width of QRS was significantly shortened in LBBaP group than that in RVSP group[(133.18±16.90)ms vs.(106.36±15.18)ms,P<0.001].There were no statistical differences in ventricular electrode perception,ventricular pacing threshold and ventricular electrode impedance between 2 groups,while operation duration and X-ray exposure time were significantly longer in LBBaP group than those in RVSP group(P<0.01).The width of QRS was significantly shortened in patients with atrioventricular node block and patients with His-Purkinje conduction system block after LBBaP without statistical difference[(106.00±7.58)ms vs.(108.90±5.34)ms,P=0.757].In LBBaP group,there were 8 patients complicated by left bundle branch block or right bundle branch block,7 with bundle branch block received correction and 5 with complete RVSP received bipolar pacing.The width of QRS was significantly was significantly shortened.Conclusion LBBaP has a higher success rate,immediate effect and safety,and stable pacing parameters in patients with AVB caused by atrioventricular node block and His-Purkinje conduction system block.Compared with RVSP,LBBaP can significantly shorten the width of QRS and maintain ventricular synchrony,especially for patients complicated by bundle branch block.