左束支起搏在心室起搏依赖患者埋藏式心脏复律除颤器植入术中应用的可行性和有效性分析

Feasibility and Effectiveness of Left Bundle-Branch Pacing in Implantable Cardioverter-defibrillator Implantation in Patients with Ventricular Pacing Dependence

目的 分析左束支起搏(LBBP)在心室起搏依赖患者埋藏式心脏复律除颤器(ICD)植入术中应用的可行性和有效性。方法 选取2019年5月至2020年10月由中国人民解放军联勤保障部队第九八〇医院心内科医生行ICD植入术的6例心室起搏依赖患者为研究对象。在患者ICD植入术中应用LBBP。收集患者基线资料、手术相关指标和术前、术后QRS波时限(QRSd)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及主要不良心血管事件(MACE)发生情况。结果 6例患者均为男性;年龄40~72岁;心电图表现:室性心动过速(VT)4例,心房颤动(AF)3例,房室传导阻滞(AVB)2例,频发室性期前收缩(VPB)2例,右束支传导阻滞(RBBB)1例,窦房结功能障碍1例,左束支传导阻滞(LBBB)0例;合并症:心源性猝死(SCD)、心肌梗死、高血压、糖尿病各1例;植入ICD类型:单腔ICD 4例,双腔ICD 2例。6例患者术中感知为9.75(8.00,11.75)mV,术中阻抗为(673.3±99.3)Ω,术中阈值为(0.72±0.23)V;无一例患者发生手术相关并发症,手术均成功。患者术前、术后QRSd、LVEDD比较,差异无统计学意义(P>0.05);患者术后LVEF高于术前(P<0.05)。随访期间1例患者因心力衰竭再住院。结论 在心室起搏依赖患者ICD植入术中应用LBBP是安全有效的,这有利于提高患者的心功能,改善其临床预后。

Objective To analyze the feasibility and effectiveness of left bundle-branch pacing(LBBP)in implantable cardioverter-defibrillator(ICD)implantation in patients with ventricular pacing dependence.Methods Six patients with ventricular pacing dependence who underwent ICD implantation by the cardiologist of 980 Hospital of PLA Joint Logistics Support Forces from May 2019 to October 2020 were selected as the research objects.LBBP was used in ICD implantation.The baseline data,operation related indexes,and QRS duration(QRSd),left ventricular ejection fraction(LVEF)and left ventricular end-diastolic dimension(LVEDD)before and after surgery,and major adverse cardiovascular events(MACE)were collected.Results All 6 patients were male;their ages were 40-72 years old;electrocardiographic manifestations:4 cases of ventricular tachycardia(VT),3 cases of atrial fibrillation(AF),2 cases of atrioventricular block(AVB),2 cases of frequent premature ventricular beats(VPB),1 case of right bundle branch block(RBBB),1 case of sinus node dysfunction,and 0 case of left bundle branch block(LBBB);comorbidities:sudden cardiac death(SCD),myocardial infarction,hypertension and diabetes were found in 1 patient respectively;the type of ICD implanted:4 cases with single-lumen ICD and 2 cases with double-lumen ICD.The intraoperative perception of 6 patients was 9.75(8.00,11.75)mV,the intraoperative impedance was(673.3±99.3)Ω,and the intraoperative threshold was(0.72±0.23)V;no patient had surgery-related complications,all patients were successfully operated.There was no significant difference in QRSd and LVEDD before and after surgery(P>0.05);LVEF after surgery was higher than that before surgery(P<0.05).During the follow-up period,one patient had readmission for heart failure.Conclusion The application of LBBP in ICD implantation in patients with ventricular pacing dependence is safe and effective,which is beneficial to improve the cardiac function and clinical prognosis of patients.