超声心动图评价左束支起搏术后导线位置的研究

Study on echocardiography to evaluate lead position after left bundle branch pacing

目的分析实现良好的左束支起搏(LBBP)患者,应用超声心动图评估导线头端在室间隔内的精确位置,为临床医生实施手术提供参考。方法选取2020年4月至2021年2月在潍坊市人民医院行LBBP术并实现良好的患者54例,回顾分析患者的超声心动图图像,总结图像特点,根据不同特征将患者分组,组间差异采用单因素方差分析,指标之间采用Pearson相关分析。结果所有患者超声心动图均能清晰显示导线位置,导线插入室间隔深度平均为(9.6±2.2)mm,头端距左室心内膜距离平均为(2.0±1.9)mm,导线头端深度与室间隔厚度比值R_(L-IVS)平均为(85±16)%,导线头端距主动脉右冠瓣根部距离D_(AV-L)平均为(23±10)mm,上部间隔组比中部间隔组D_(AV-L)数值小且差异有统计学意义(P<0.01),R_(L-IVS)垂直组比斜行组大且差异有统计学意义(P<0.01),其余比较差异均无统计学意义。D_(AV-L)与左室内径有较弱的相关性,相关系数差异有统计学意义(P<0.01)。结论实施LBBP时,是否夺获左束支传导系统的重要评估因素是R_(L-IVS),而不是导线插入室间隔的深度;且导线插入的角度对R_(L-IVS)数值有一定影响,但R_(L-IVS)的理想阈值仍需进一步研究。

Objective To evaluate the precise position of the lead tip in the ventricular septum with echocardiography and provide references for clinicians to perform surgery for the left bundle branch pacing(LBBP)patients by analyzing good LBBP cases.Methods Fifty-four patients with LBBP were enrolled and their echocardiographic characteristics of the pacing electrode were analyzed.Patients were divided into groups according to different characteristics.Differences between the groups and relationships between different indexes were analyzed by one-way ANOVA method and Pearson correlation analysis.Results The lead tip of all patients could be displayed clearly by echocardiography.The average length of lead in the interventricular septum was(9.6±2.2)mm,and the average distance from the lead tip to the endocardium of the left ventricle was(2.0±1.9)mm.The average ratio of lead tip depth to interventricular septum thickness(R_(L-IVS))was(85±16)%.The average distance between the lead end and the root of the right aortic coronary valve(D_(AV-L))was(23±10)mm.The value of D_(AV-L)in upper interval group was smaller than that in middle interval group and the difference was statistically significant(P<0.01).R_(L-IVS)in the vertical group was larger than that in the oblique group and the difference was statistically significant(P<0.01).The other differences were not statistically significant(P>0.05).There was a weak correlation between D_(AV-L)and the left ventricle diameter,and the correlation coefficient was statistically significant(P<0.01).Conclusion R_(L-IVS),rather than the depth of lead insertion into the ventricular septum,is an important factor in determining whether the left bundle branch conduction system is captured during LBBP.Moreover,the angle of wire insertion has a certain effect on the value of R_(L-IVS),and the ideal threshold of R_(L-IVS)still needs to be further studied.