左束支区域起搏术中室间隔心肌的损伤电流变化

Changes of ventricular septal myocardial injury current in left bundle branch area pacing

目的探讨左束支区域起搏(left bundle branch area pacing,LBBAP)术中室间隔心肌的损伤电流变化特点。方法回顾性分析江苏省无锡市第二人民医院2020年1月至2022年11月行永久性起搏器植入患者的临床资料。其中行LBBAP 42例(LBBAP组),行右心室间隔部起搏(right ventricular septum pacing,RVSP)56例(RVSP组)。比较两组患者电极植入术中的常规参数阈值、感知和阻抗,电极旋出前和到位后0、5、10 min的损伤电流值,以及损伤电流与常规参数的相关性。计量资料以x¯±s表示,两组间比较采用t检验,两组多个时点间比较采用重复测量的方差分析;计数资料以例(%)表示,组间比较采用χ^(2)检验;两个变量的相关性分析采用Pearson相关分析法。结果两组患者电极植入术中起搏阈值、感知和阻抗比较差异均无统计学意义(均P>0.05)。LBBAP组电极旋出前和到位后0、5、10 min各时点损伤电流值均高于RVSP组[(7.19±1.26)mV比(5.33±0.79)mV,(22.50±3.06)mV比(10.85±1.70)mV,(15.75±2.63)mV比(8.01±1.09)mV,(9.24±2.00)mV比(5.51±0.98)mV],两组患者电极到位后0 min损伤电流值均高于电极旋出前,之后两组均逐渐降低,LBBAP组电极到位后10 min损伤电流值仍高于电极旋出前水平(均P<0.05),而RVSP组与电极旋出前水平比较差异无统计学意义(P>0.05)。LBBAP组电极到位后0 min损伤电流值与室间隔厚度、左心室后壁厚度均呈正相关(r值分别为0.45和0.46,P值分别为0.003和0.002),与常规起搏参数阻抗呈负相关(r=-0.32,P=0.037),与阈值和感知未见相关关系(r值分别为0.08和0.01,P值分别为0.604和0.968)。RVSP组电极到位后0 min损伤电流值与阈值呈负相关(r=-0.28,P=0.036)。结论LBBAP室间隔心肌损伤电流值在电极旋出后显著升高,电极到位后0 min损伤电流值与室间隔厚度、左心室后壁厚度均呈正相关,与电极阻抗呈负相关,而与阈值、感知未见相关关系。

Objective Explore the characteristics of injury current changes in ventricular septal myocardium during left bundle branch area pacing(LBBAP)surgery.Methods Retrospective analysis of clinical data of patients who underwent permanent pacemaker implantation at The Second People's Hospital of Wuxi in Jiangsu Province from January 2020 to November 2022.Among them,42 patients were treated with LBBAP(LBBAP group)and 56 patients with Right ventricle septum pacing(RVSP group).Compare the conventional parameters such as threshold,perception,impedance during electrode implantation,damage current values at 0,5,and 10 minutes before and after electrode rotation,and the correlation between damage current and conventional parameters.The measurement data is represented by x¯±s,analysis of variance is used for comparison between multiple groups,t-test is used for comparison between two groups,and repeated measurement analysis of variance is used for comparison between two groups at multiple time points;Counting data is represented as an example(%),and inter group comparisons are made usingχ^(2) Inspection;Pearson correlation analysis was used to analyze the correlation between the two variables.Results There was no statistically significant difference in pacing threshold,perception,and impedance between the two groups of electrode implantation surgery(all P>0.05).The damage current values at 0,5,and 10 minutes before and after electrode rotation in the LBBAP group were higher than those in the RVSP group[(7.19±1.26)mV compared to(5.33±0.79)mV,(22.50±3.06)mV compared to(10.85±1.70)mV,(15.75±2.63)mV compared to(8.01±1.09)mV,(9.24±2.00)mV compared to(5.51±0.98)mV].The damage current values at 0 minutes after electrode rotation in both groups were higher than before electrode rotation,and gradually decreased thereafter,After 10 minutes of electrode placement,the damage current value of the LBBAP group was still higher than the level before electrode rotation(all P<0.05),while there was no statistically significant difference between the RVSP group and the level before electrode rotation(P>0.05).The damage current value at 0 minutes after the LBBAP group electrode was in place was positively correlated with ventricular septal thickness and left ventricular posterior wall thickness(r values 0.45 and 0.46,P values 0.003 and 0.002,respectively),and negatively correlated with conventional pacing parameter impedance(r=-0.32,P=0.037).There was no correlation with threshold and perception(r values 0.08 and 0.01,P values 0.604 and 0.968,respectively).The damage current value at 0 minutes after the RVSP group electrode was in place was negatively correlated with the threshold(r=-0.28,P=0.036).Conclusions The COI value of LBBAP interventricular septum myocardium increased significantly after the electrode was rotated out.The COI value at 0 min after the electrode put in place was positively correlated with the interventricular septum thickness and left ventricular posterior wall thickness,and negatively correlated with the electrode impedance,but there was no correlation with threshold and perception.