持续性心房颤动伴心动过缓患者左束支区域起搏效果

Pacing effect of left bundle branched area pacing in patients with persistent atrial fibrillation and bradycardia

目的 探讨左束支区域起搏(LBBAP)在持续性心房颤动(简称房颤)合并心动过缓患者中治疗的临床效果。方法 连续纳入自2019年10月至2020年4月的持续房颤合并心动过缓需要起搏治疗且超声评估左室射血分数≤0.35并接受LBBAP的患者。术中记录导线参数,术后3个月、6个月及1年随访起搏器程控参数和起搏相关并发症,以及术后1年超声心动图评估,对比基线、术后1年各项参数的变化。结果 连续入选共41例患者,年龄为(68.9±11.0)岁,其中男性占比73.2%(30/41)。LBBAP的手术成功率为97.6%(40/41)。术后起搏QRS波时限较术前基线心电图QRS波时限无明显变化[(115.2±9.6) ms vs (110.8±20.3) ms,P=0.145]。LBBAP的心室电极中位植入时间为12(6.0,25.0)min,中位X线暴露时间为4.6(3.0,7.8)min。心室起搏平均阈值为(0.7±0.2)V。随访(13.3±7.0)个月,起搏比例达83.3%(48.3%,96.5%),随访心室起搏阈值(0.8±0.3) V。围手术期有2例在电极拧入过程中出现室间隔穿孔,经回撤起搏电极调整植入位点后均成功施行LBBAP且患者无临床症状,余患者在围手术期和随访期间均未出现任何起搏相关并发症。术后1年随访与基线对比左室射血分数(0.60±0.07 vs 0.60±0.06,P=0.243)和左室舒张末直径[(51.6±6.7) mm vs (52.1±6.6) mm,P=0.449]均无明显变化,但左房前后径较术前显著缩小[(50.1±10.9) mm vs (47.6±1.4) mm,P=0.013]。结论 持续性房颤心动过缓患者接受LBBAP治疗1年随访起搏参数稳定,维持窄QRS波时限,且可能有助于逆转左房重构。

Objective To explore the pacing effect of left bundle branched area pacing(LBBAP)in patients with persistent atrial fibrillation(AF)and bradycardia.Methods Consecutive patients with persistent AF and bradycardia requiring ventricular pacing were included if they underwent LBBAP from October 2019 to April 2020.The electrocardiogram and pacing parameters were recorded at implant,and at 3-month,6-month and 12-month follow-up after procedure.Echocardiography was assessed at baseline and12-month follow-up.Results Totally 41 patients were included with the age of(68.9±11.0)years,and male of 73.2%.LBBAP was successful in 97.6%(40/41)of patients with paced QRS duration similar to intrinsic QRS duration[(115.2±9.6)ms vs(110.8±20.3)ms,P=0.145].The procedure time for LBBAP lead was 12(6.0,25.0)minutes and the fluoroscopy time was 4.6(3.0,7.8)minutes.During follow-up of(13.3±7.0)months,the pacing thresholds were comparable between baseline and last visit of follow-up[(0.7±0.2)V vs(0.8±0.3)mV,P>0.05)].The percentage of ventricular pacing was 83.3%(48.3%,96.5%)and device-related complications were not observed during follow-up.Echocardiography at 12-month follow-up showed no difference in the left ventricular end diastolic diameter[(51.6±6.7)mm vs(52.1±6.6)mm,P=0.449]and left ventricular ejection fraction[(0.60±0.07)vs(0.61±0.066),P=0.243]when compared that at baseline.The mean left atrial diameter was significantly reduced after LBBAP at 12-month follow-up thanbaseline[(47.6±1.4)mm vs(50.1±10.9)mm,P=0.013].Conclusion LBBAP in patients with persistent AF and bradycardia could achieve stable pacing parameters,narrow paced QRS duration,and may have effect onreversing the left atrial remodelling.