左束支起搏置入失败原因分析

Analysis for failure of left bundle branch pacing

目的:回顾分析我院开展的左束支起搏病例,评估左束支起搏的可行性和安全性,分析失败病例的原因。方法:收集2018年9月至2022年3月,在我院心内科诊治的行左束支区域起搏88例患者的临床资料,分析术前临床资料、术中情况、随访情况,分析失败原因。结果:88例患者男性62例,女性26例,平均年龄(72±12)岁,79例成功完成左束支起搏手术(90%)。术前窄QRS者,术后QRSd无明显变化[(97±8)vs.(98±8)ms,P>0.05];QRSd介于120~150ms之间和QRSd>150ms者,术后QRS明显缩短[(133±9)vs.(107±11)ms,(165±13)vs.(100±7)ms,P<0.01],且随访起搏器参数和QRSd稳定。9例失败,9患者均存在特殊或复杂的临床情况,8例更改手术方案完成手术。失败病例手术时间明显延长,术前心房颤动、心力衰竭、慢性阻塞性肺疾病、传统CRT无应答、心外科手术史多(P<0.01),LVEF更低(P<0.01),LAD、LVEDD、RAD、RVD值更大(P<0.01)。房室扩大致手术失败比例最高(66.8%)。结论:左束支起搏手术成功率较高,可行性和安全性较好,复杂病例应提前预案,提高手术成功率。

Objective:The aim of this study was to access the feasibility and outcomes of left bundle branch pacing(LBBP)in our center by retrospectively analyze the patients who underwent LBBP,and the failure reasons were also detailed analyzed.Methods:LBBP was attempted in 88 patients who were admitted in our center from September 2018 to March 2022.Their pre-operation clinical characteristics,intraoperative conditions and outcomes were analyzed in detail,and the reasons for failure were found out.Results:Eightyeight patients(62 males and 26 females)aged 45-85 years,average age(72±12)years were attempted LBBP.Seventy-nine patients were succeeded(90%).QRSd of those patients whose were narrow had no significant change after operation[(97±8)vs.(98±8)ms,P>0.05].QRSd of those patients whose were among 120ms and 150ms or longer than 150ms was significantly shorter than before[(133±9)vs.(107±11)ms,(165±13)vs.(100±7)ms,P<0.01].All the parameters were stable when followed up.Nine were failed.And special or complicated conditions existed in all the 9 patients.Eight of them changed the surgical planning and finished.The time of operation were significantly longer.Patients who failed LBBP have more conditions of atrial fibrillation,heart failure,COPD,no response of traditional CRT,history of cardiac surgery(P<0.01)before operation and had less LVEF,higher value of LAD,LVEDD,RAD,RVD(P<0.01).The highest proportion(66.8%)of the reasons for failure was dilation of atrium and ventricle.Conclusions:LBBP is feasible and safe and could remarkable operation success rate.When encountering complex clinical conditions,preparing materials or changing surgical program may help to improve success rate.