希氏-浦肯野系统起搏与双心室起搏治疗房室传导阻滞伴射血分数降低患者的疗效观察

Efficacy of His-Purkinje conduction system pacing versus biventricular pacing in the treatment of patients with atrioventricular block and reduced left ventricular ejection fraction

目的评估希氏-浦肯野系统起搏(HPCSP)与双心室起搏治疗房室传导阻滞伴射血分数降低患者的安全性和有效性。方法本研究为单中心、回顾性、观察性临床研究。连续入选2017年7月至2021年5月在南京大学医学院附属鼓楼医院行永久起搏器植入术的房室传导阻滞伴左心室射血分数(LVEF)<50%患者,根据采用起搏手术方式的不同,分为2组:双心室起搏组和HPCSP组。观察和比较两组患者手术时间、X线曝光时间、手术相关并发症发生情况、术后QRS时限以及术后1年超声心动图、心功能(NYHA分级)、死亡、心力衰竭再入院等指标。结果共入选116例患者,年龄(69.6±12.3)岁,其中男74例。与双心室起搏组(62例)相比,HPCSP组(54例)的总手术时间[(103.1±40.0)min对(119.8±45.8)min,P=0.041]和X线曝光时间[(11.8±7.6)min对(15.0±8.5)min,P=0.036]明显缩短,术后QRS时限也明显缩短[(120.5±14.6)ms对(146.5±18.2)ms,P<0.001];两组患者围术期手术并发症的发生率差异无统计学意义(P>0.05)。术后1年超声心动图结果显示HPCSP组和双心室起搏组患者LVEF均较术前改善,但两组间差异无统计学意义(47.9%±8.1%对45.8%±8.7%,P=0.182);两组患者术后1年的心功能、死亡、心力衰竭再入院等指标差异均无统计学意义(P>0.05)。结论对于房室传导阻滞伴射血分数降低患者,HPCSP和双心室起搏均可有效改善心脏收缩功能障碍,提高LVEF,两种起搏方案1年的临床预后类似。

Objective To investigate the safety and efficacy of His-Purkinje conduction system pacing(HPCSP)and biventricular pacing in the treatment of patients with atrioventricular block(AVB)and reduced left ventricular ejection fraction(LVEF).Methods Patients with AVB and LVEF<50%from July 2017 to May 2021 who attempted biventricular pacing or HPCSP in Department of Cardiology,Drum Tower Hospital Affiliated to Medical School of Nanjing University were enrolled.According to the different procedure methods,the enrolled patients were divided into two groups:HPCSP group and biventricular pacing group.The procedure time,X-ray exposure time,procedural complications,post-procedure QRS duration and echocardiography,New York Heart Association(NYHA)classification,death,heart failure re-hospitalization 1 year after operation were observed and compared between the two groups.Results Of the 116 enrolled patients[age(69.6±12.3)years,63.8%(74/116)male],62 patients were in the biventricular pacing group,and 54 patients were in the HPCSP group.Compared with biventricular pacing group,the procedure time was significantly shorter in HPCSP group[(103.1±40.0)min vs.(119.8±45.8)min,P=0.041],and the total X-ray exposure time was significantly reduced[(11.8±7.6)min vs.(15.0±8.5)min,P=0.036],the post-procedure QRS duration was significantly shorter[(120.5±14.6)ms vs.(146.5±18.2)ms,P<0.001].There was no significant difference in the incidence of procedural complications between the two groups(P>0.05).The results of echocardiography 1 year after operation showed that the LVEF of HPCSP group and biventricular pacing group were 47.9%±8.1%and 45.8%±8.7%,respectively,which were both improved compared with those before operation,but there was no significant difference between the two groups(P=0.182).The NYHA classification,death and heart failure re-hospitalization one year after operation were similar between the two groups(P>0.05).Conclusion Both HPCSP and biventricular pacing can effectively improve cardiac systolic dysfunction and increase LVEF in patients with AVB and reduced LVEF,and the clinical outcomes of the two pacing regimens at one year are similar.