犬左束支区域起搏与心室不同部位起搏的心电学及急性血流动力学比较研究

Effects of left bundle branch area pacing and different ventricular sites pacing on cardiac electrophysiology and acute hemodynamics in canines

目的对健康实验犬行左束支区域起搏(LBBAP),并与心室不同部位起搏的心电学及急性血流动力学参数进行比较。方法本研究选取2020年10月至2021年10月由中国医学科学院阜外医院实验动物中心提供的5只犬,在X线影像指导下进行LBBAP及心室不同部位起搏(希氏束、右心室流出道、右心室间隔、右心室心尖部、左心室间隔及左心室心尖部),分析并比较LBBAP及心室不同部位起搏的QRS时限和左心室达峰时间(S-LVAT)以及左心室压力最大上升速率(dp/dt max)。结果本研究5只犬均成功行LBBAP,LBBAP与希氏束起搏在改善QRS时限[(108.0±3.2)ms比(109.7±1.6)ms,P>0.05]、S-LVAT[(61.0±2.6)ms比(61.0±3.3)ms,P>0.05]以及左心室dp/dt max[(1114.1±34.8)mmHg/s比(1107.4±34.8)mmHg/s,P>0.05]方面的差异无统计学意义。与心室其他部位起搏相比,LBBAP能够明显缩短QRS时限及S-LVAT,明显增加左心室dp/dt max(P均<0.001)。结论LBBAP与希氏束起搏对犬的心电学及急性血流动力学影响相似,均明显优于心室其他部位起搏。

Objective To explore the effects of the left bundle branch area pacing(LBBAP)and different ventricular sites pacing on cardiac electrophysiology and acute hemodynamics in canines.Methods A total of 5 canines were included in the study at The Animal Experimental Center,Fuwai HospitaI from October 2020 to October 2021.Using X-ray imaging,the LBBAP and different ventricular sites pacing(including His bundle,right ventricular outflow tract,right ventricular septum,right ventricular apex,left ventricular septum and left ventricular apex)were conducted.The QRS duration and stimulus to left ventricular activation time(S-LVAT)as well as the first derivative of left ventricular pressure(LV dp/dt max)were recorded and compared between LBBAP and different ventricular sites pacing.Results All the 5 canines received successful LBBAP.No significant differences in QRS duration[(108.0±3.2)ms vs.(109.7±1.6)ms,P>0.05]and S-LVAT[(61.0±2.6)ms vs.(61.0±3.3)ms,P>0.05]as well as LV dp/dt max[(1114.1±34.8)mmHg/s vs.(1107.4±34.8)mmHg/s,P>0.05]were observed between the LBBAP and His bundle pacing(HBP).Compared with the other different ventricular sites pacing,LBBAP significantly decreased QRS duration and S-LVAT,and increased LV dp/dt max(P<0.001).Conclusion Both LBBAP and HBP could provide better electrical resynchronization and acute hemodynamics improvement when compared with the other different ventricular sites pacing.