永久性希氏束起搏治疗慢性心力衰竭伴完全性左束支传导阻滞1例

A Case of Permanent His Bundle Pacing in the Treatment of Chronic Heart Failure Combined with Complete Left Bundle Branch Block

希氏束起搏(HBP)是唯一能模拟正常心脏激动和传导的起搏方式,是最生理性的心室起搏方式,相比传统的右心室起搏(RVP)和双心室起搏(BVP)可获得更好的电和机械同步性。本例患者为慢性心力衰竭伴完全性左束支传导阻滞(CLBBB),因左右心室收缩不同步导致心脏明显扩大,反复发作心力衰竭住院治疗,有明确的心脏再同步治疗(CRT)指征。成功植入HBP后以极低的起搏阈值(0.2 V/0.4 ms)纠正了CLBBB,术后随访患者的心功能明显改善。但起搏器植入术后1周,患者体表心电图突然出现QRS波增宽伴形态改变,继续随访1年后,体表心电图最终演变成完全性右束支传导阻滞(CRBBB),推测可能与HBP电极植入过程中损伤了右束支有关。本病例为HBP纠正慢性心力衰竭伴CLBBB提供了远期预后结果和新的治疗思路。

His bundle pacing (HBP) is the only pacing mode that can simulate normal cardiac activation and conduction,it is the most physiological ventricular pacing mode,compared with traditional right ventricular pacing (RVP) and biventricular pacing (BVP),it can obtain better electrical and mechanical synchronization.This patient was chronic heart failure combined with complete left bundle branch block (CLBBB),the heart expanded significantly due to the asynchrony of left and right ventricular contraction,he was hospitalized for recurrent heart failure and had clear indications of cardiac resynchronization therapy (CRT).After successful implantation of HBP,the pacing threshold was very low (0.2 V/0.4 ms),after correcting CLBBB,the cardiac function of patients was significantly improved.However,one week after pacemaker implantation,the patient’s body surface ECG suddenly showed QRS wave broadening with morphological changes,after continuous follow-up for one year,the body surface ECG finally evolved into complete right bundle branch block (CRBBB),we speculated that it may be related to the injury of right bundle branch during HBP electrode implantation.This case provided long-term prognosis and new treatment ideas for HBP to correct chronic heart failure with CLBBB.