左束支优化心脏再同步治疗对老年心力衰竭患者心功能的影响

Effect of left bundle branch-optimized cardiac resynchronization therapy on heart function in elderly HF patients

目的探讨左束支优化心脏再同步治疗(LOT-CRT)对老年射血分数减低的心力衰竭(HFrEF)患者心功能的影响。方法选择2019年6月~2020年12月在我院接受LOT-CRT治疗HFrEF患者7例,采用Medtronic 3830电极经C315鞘从右心室间隔面深拧至左心室间隔左束支区域,通过阴极单极起搏后V_(1)导联呈Qr或QR型以及不同电压起搏的左心室达峰时间(LVAT)一致,记录到局部左束支电位确认为左束支起搏(LBBP),左心室起搏采用双阴极电极Medtronic 4296经冠状窦置入至侧后分支。随访6个月,测定电极参数及心功能。结果所有患者均成功置入3830电极并获得良好参数,2例因左心室起搏阈值高未置入左心室电极,术后根据起搏后QRS宽度决定采用单LBBP或联合左心室起搏,3例为单LBBP。与术前比较,术后6个月随访QRS波明显缩窄[(131.3±30.1)ms vs(164.0±19.6)ms,P<0.05],左心室舒张末期内径降低[(56.4±10.6)mm vs(63.0±9.2)mm,P<0.05],LVEF提高[(45.4±9.7)%vs(30.7±5.2)%,P<0.05],术后NYHAⅡ级比例明显高于术前(100.0%vs 14.2%,P<0.05),左心室16节段收缩达峰时间标准差明显改善[(18.7±5.1)%vs(8.1±3.0)%,P<0.05]。结论LBBP可获得良好参数,安全,稳定,LOT-CRT可有效改善左心室收缩的同步性,使老年心力衰竭患者心功能明显提高,并可作为传统CRT治疗无反应患者的有效替代,部分患者单LBBP即可纠正心力衰竭。

Objective To study the effect of LOT-CRT on heart function in elderly HFrEF patients.Methods Seven HFrEF patients who underwent LOT-CRT in our hospital from June 2019 to December 2020 were included.The Qr or QR pattern on lead V_(1) and identical LVAT on lead V_(5-6) after catholic monopolar pacing were achieved by screwing the Medtronic 3830 electrode into the left bundle branch of left ventricular septum from the right ventricular septum via the C315 sheath.The left bundle branch pacing(LBBP)determined according to the local left bundle branch electrical potential,left ventricular epicardial pacing was performed by immigrating double Medtronic 4296 cathodal leads into the lateral posterior branch through the coronary sinus.The electrode parameters and heart function were measured after 6 months of follow up.Results The Medtronic 3830 electrode was successfully immigrated into all patients with good parameters.However,4296 lead was not immigrated into 2 patients due to the high left ventricular pacing threshold.LBBP alone was achieved for three patients and LBBP combined with left ventricular pacing in other four patients according to their postoperative QRS.The QRS wave was significantly narrower,the LVEDD were significantly reduced,the LVEF and ratio of NYHAⅡwere significantly higher in elderly HFrEF patients after operation than before operation(131.3±30.1 ms vs 164.0±19.6 ms,56.4±10.6 mm vs 63.0±9.2 mm,45.4%±9.7%vs 30.7%±5.2%,100.0%vs 14.2%,18.7%±5.1%vs 8.1%±3.0%,P<0.05).Conclusion Left bundle branch pacing can achieve good parameters with a high safety and stability.LOT-CRT can effectively improve the systolic synchronization of left ventricle and heart function in elderly HFrEF patients,and can thus be used as an alternative method for non-responders of conventional CRT.Left bundle branch pacing alone can improve HF in some elderly HFrEF patients.