左束支起搏进行心脏再同步化治疗的疗效研究

Efficacy and safety of left bundle branch pacing for cardiac resynchronization

目的研究左束支起搏作为心脏再同步化治疗的疗效。方法纳入2019年1月至2021年1月在福建省立医院行心脏再同步化治疗起搏器(cardiac resynchronization therapy pacemaker,CRT-P)植入术的患者49例进行回顾性分析。根据植入术式的不同分为左束支-左心室起搏组(left bundle branch pacing-left ventricular pacing,LBBP-LVP组,26例)和双心室起搏组(biventricular pacing,BivP组,23例)。比较各组术前术后的心电图、心脏超声和心功能分级。结果LBBP-LVP组术后QRS波宽度窄于BivP组[(107.8±8.8)ms比(118.7±10.2)ms,P<0.001]。在术后6个月随访时,LBBP-LVP组与BivP组相比,LBBP-LVP左心室射血分数更高[(50.1±5.8)%比(44.0±5.1)%,P<0.001],左心室舒张末内径更小[(48.6±4.3)mm比(54.2±8.0)mm,P=0.006],纽约心功能分级更好[(1.3±0.5)级比(1.9±0.7)级,P=0.003]。结论与BivP相比,LBBP-LVP具有更好的心脏电同步性,能更明显改善心脏结构和心功能。

Objective To evaluate the safety and efficacy of left bundle branch pacing for cardiac resynchronization therapy.Method A retrospective analysis was conducted on 49 patients who underwent implantation of cardiac resynchronization therapy pacemaker(CRT-P)in Fujian Provincial Hospital from January 2019 to January 2021.They were divided into left bundle branch pacing-left ventricular pacing(LBBP-LVP)group(n=26)and biventricular pacing(BivP)group(n=23)according to different implantation methods.The data of electrocardiogram(ECG),echocardiography and cardiac function classification before and after operation were compared.Result The width of postoperative QRS wave in LBBP-LVP group was narrower than that in BivP group[(107.8±8.8)ms vs(118.7±10.2)ms,P<0.001].At 6-month postoperative follow-up,LBBP-LVP group had higher left ventricular ejection fraction[(50.1±5.8)%vs(44.0±5.1)%,P<0.001],smaller left ventricular end diastolic diameter[(48.6±4.3)mm vs(54.2±8.0)mm,P=0.006],and better grade of the New York Heart Association(NYHA)classification[(1.3±0.5)vs(1.9±0.7),P=0.003]than BivP group.Conclusion Compared with BivP,LBBP-LVP has better electrical synchronization after implantation,and can significantly improve heart structure and heart functions.