分析希氏束起搏应用于老年缓慢型心律失常的优势

The advantage of hib bundle pacing in elderly patients with slow arrhythmia

目的:分析希氏束起搏(his bundle pacing,HBP)应用于老年缓慢型心律失常的优势。方法:随机连续性纳入具备起搏器Ia类植入指征的缓慢型心律失常(包括病态窦房结综合征(sick sinus syndrome,SSS)和房室传导阻滞(atrioventricular block,AVB))的老年患者(年龄超过65岁)共138例,所有患者均予我院心内科行心脏永久起搏器植入术,其中行右心室心尖部起搏(right ventricular apical pacing,RVAP)的患者归为RVAP组(n=80),行希氏束起搏(HBP)的患者归为HBP组(n=58),通过二维斑点追踪成像(two dimensional speckle-tracking imaging,2D-STI)和组织多普勒成像(tissue Doppler imaging,TDI)技术测量反应左心室收缩同步性的指标,并比较分析各指标在两组之间的差异性;同时比较两组患者起搏器植入前及植入12个月后心脏功能、心脏结构以及QRS波时限的差异性。结果:HBP组反映左心室收缩同步性的指标显著小于RAVP(包括Trs-SD、Trs-Dif、Tas-post、Ts-SD、Ts-Dif以及QRS波时限);同时,HBP植入12个月后患者心功能得到显著改善;同时植入12个月后,比较发现,RVAP组患者左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心房内径(left atrial diameter)以及QRS波时限显著大于HBP组;差异均具备统计学意义。结论:HBP应用于老年缓慢型心律失常患者优于RVAP,体现在左心室收缩同步性更高,心功能改善改善。

Objective To analyze the advantage of hib bundle pacing(HBP)in elderly patients with slow arrhythmia.Methods All of 138 slow arrhythmia(including sick sinus syndrome(SSS)and atrioventricular block(AVB))elderly patients with age>65 years who were given cardiac permanent pacemaker implantation at the department of cardiology in our hospital.All of them were divided into right ventricular apical pacing(RVAP)group(n=80)and HBP group(n=50)according to the site of pacing.Two-dimensional speckle-track imaging(2D-STI)and Tissue Doppler imaging(TDI)techniques were used to measure the index of left ventricular systolic synchrony,and those indexes were compared between two groups;comparison of cardiac function,cardiac structure and QRS duration before and after pacemaker implantation in two groups.Results The indexes of left ventricular systolic synchrony(including Trs-SD,Trs-Dif,Tas-post,Ts-SD,Ts-Dif and QRS durations).in BHP group were significantly lower than RAVP group;at the same time,the cardiac function was significantly improved after 12 months with HBP,meanwhile,the left ventricular end diastolic diameter(LVEDD)and left atrium diameter(LAD)and QRS durations in RVAP group were significantly higher than HBP group at 12 months after surgery.Conclusion HBP improved left ventricular systolic synchrony and cardiac function and was more suitable for elderly patients with slow arrhythmia than RVAP.