左束支区域起搏与间隔部起搏对起搏参数和心电图及超声心动图参数影响分析

Effects of left bundle branch regional pacing and septal pacing on pacing parameters,ECG and echocardiographic parameters

目的探讨左束支区域起搏(LBBP)与间隔部起搏(RVSP)对起搏参数、心电图及超声心动图参数影响。方法选取2019年1月至2021年6月青海省心脑血管病专科医院收治的60例房室传导阻滞(AVB)患者,均行人工永久性心脏起搏器置入,根据心室导线置入的部位,分为LBBP组(30例)和RVSP组(30例),比较两组术后即刻、术后1个月、术后6个月、术后12个月的起搏参数(感知、阈值、阻抗)、心电同步性(QRS时限、QTc间期、QRS形态)、机械同步性[左心室舒张末期内径(LVEDD)、左心室侧壁基底段与右心室游离壁基底段收缩速度峰值时间差(Ts-LV-RV)、左心室射血分数(LVEF)、左心室充盈时间与RR间期比值(LVFT/RR)]及并发症。结果两组术后即刻起搏参数、心电同步性、机械同步性等指标差异无统计学意义(P>0.05);两组感知、阈值、阻抗组间、时点间、组间·时点间比较,差异均无统计学意义(P>0.05);两组QRS波时限组间、时点间、组间时点间比较,差异有统计学意义(P<0.05);LBBP组术后1个月、术后6个月、术后12个月QRS波时限(F=24.807、9.752、14.385)、QTc间期(F=18.061、9.802、13.185)低于RVSP组(P<0.05);两组Ts-LV-RV、LVFT/RR组间、时点间、组间·时点间比较,差异有统计学意义(P<0.05);组间比较显示,LBBP组术后1个月、术后6个月、术后12个月Ts-LV-RV(F=5.714、14.257、0.783)、LVFT/RR(F=4.492、9.736、0.749)低于RVSP组(P<0.05);两组均无室间隔穿孔、囊袋出血、导线脱位等发生,无再发心力衰竭、快速性心律失常住院或死亡等相关事件。结论相对于RVSP,LBBP对患者心功能影响较小,有利于患者AVB纠正,保持良好的机械同步性,保护心脏结构,预后较好。

Objective To investigate the effects of left bundle branch pacing(LBBP)and septal pacing(RVSP)on pacing parameters,ECG and echocardiographic parameters.Methods A total of 60 patients with atrioventricular block(AVB)who were admitted to Qinghai Provincial Cardiovascular and Cerebrovascular Disease Hospital from January 2019 to June 2021 were selected.All the patients underwent artificial permanent cardiac pacemaker implantation.According to the location of the ventricular lead placement,they were divided into LBBP group(30 cases)and RVSP group(30 cases).The pacing parameters(perception,threshold,impedance),ECG synchronization(QRS duration,QTc interval,QRS morphology),mechanical synchronization(left ventricular end-diastolic diameter(LVEDD),left ventricular lateral wall basal segment and right ventricular free wall basal segment time difference between peak systolic velocity(Ts-LV-RV),left ventricular ejection fraction(LVEF),left ventricular filling time to RR interval ratio(LVFT/RR)]and complications of the 2 groups were compared between the two groups immediately after surgery,1 month after surgery,6 months after surgery,and 12 months after surgery.Results There were no significant differences in immediate pacing parameters,electrocardiogram synchronization and mechanical synchronization between the two groups(P>0.05).There was no significant difference in perception,threshold,impedance between 2 groups,between time points,between groups and between time points(P>0.05);there were statistically significant differences between the two groups in terms of QRS complex duration between groups,time points,and time points between groups(P<0.05);the QRS complex duration(F=24.807,9.752,14.385)and QTc interval(F=18.061,9.802,13.185)in the LBBP group were lower than those in the RVSP group at 1 month,6 months,and 12 months after the operation(P<0.05);there were statistically significant differences in Ts-LV-RV,LVFT/RR between the two groups,between time points,between groups and between time points(P<0.05);comparison between groups showed that in LBBP group,Ts-LV-RV(F=5.714,14.257,0.783),LVFT/RR(F=4.492,9.736,0.749)at 1 month,6 months,and 12 months after operation)was lower than that in the RVSP group(P<0.05);there were no ventricular septal perforation,capsular hemorrhage,lead dislocation,etc.in both groups,and there were no related events such as recurrent heart failure,tachyarrhythmia hospitalization or death.Conclusion Compared with RVSP,LBBP has less effect on the cardiac function of the patients,which is beneficial to the correction of AVB,maintains good mechanical synchronization,protects the cardiac structure and has a better prognosis.