希氏束起搏与右心室间隔部起搏的临床对比研究

Clinical comparison study of His bundle pacing and right ventricular septum pacing

人工心脏起搏是目前临床上治疗症状性心动过缓最有效和最成熟的方式,其挽救了数以万计患者的生命[1]。右室心尖部是既往最常用的起搏部位,许多临床研究证实右室心尖部起搏会改变心脏正常激动顺序,使心室收缩失同步导致心功能不全、瓣膜反流及心房颤动(房颤)等[2-3]。右心室间隔部起搏(RVSP)相较于心尖部起搏是否更具有优势,目前尚无定论[4]。希氏束起搏(HBP)通过激动希浦传导系统,理论上是目前最为符合生理性的起搏方式[5]。

Objective: To compare the electrical parameters and clinical effects of His bundle pacing(HBP) and right ventricular septum pacing(RVSP). Methods: The clinical data of 48 patients who underwent pacemaker implantation in the Department of Cardiology, The First Affiliated Hospital of Zhengzhou University from January to December 2018 were retrospectively analyzed.According to the different pacing sites, the patients were divided into the His bundle pacing group(20 cases) and the right ventricular septum pacing group(28 cases).The preoperative baseline data, the operation time, pacing parameters, ECG parameters, cardiac function parameters, and the occurrence of surgery-related complications were recorded and compared between the two groups immediately, 3, 12 months after surgery, and the last follow-up. Results:The mean follow-up was(2.04±0.39) years.Comparing the two groups immediately during the operation, 3, 12 months after the operation, and the last follow-up, the threshold of the His bundle pacing group was significantly higher than that of the septum pacing group[Immediately during surgery(1.15±0.34) V:(0.86±0.28) V,P=0.005]. In contrast, the R wave amplitude was significantly lower than that of the septum pacing group[Immediately during surgery(6.73±1.60) mV:(8.90±2.49) mV, P=0.003].Compared within the group, the last follow-up threshold of the His bundle pacing group and the septum pacing group were significantly higher than those immediately after the operation[(1.39±0.25) V:(1.15±0.34) V, P=0.017;(1.12±0.33) V:(0.86±0.28) V, P=0.008], R wave amplitude is significantly reduced(P<0.05). The QRS wave duration in the septal pacing group was significantly longer than that before the operation, and significantly longer than that of the His bundle pacing group at the same time[Intraoperative(116.60±13.53) ms:(102.10±7.26) ms, P=0.000]. The last follow-up LVEF value of the His bundle pacing group was significantly higher than that of the septum pacing group[(63.40±2.58)%:(61.50±2.12)%, P=0.015], the LVEDD value was significantly lower than that of the septum pacing group[(43.30±5.29) mm:(46.85±4.68) mm, P=0.031].Compared within the group, the LVEF value at the last follow-up in the His bundle pacing group was significantly higher than that before the operation[(60.90±3.54)%:(63.40±2.58)%, P=0.015]. There was no statistically significant difference between the two groups regarding surgical safety and postoperative complications(P>0.05). Conclusion:Compared with right ventricular septum pacing, His bundle pacing is equally safe and effective, and His bundle pacing is more physiological and can improve the heart function of patients. The long-term effect needs more research.