利用造影图像指导法指导左束支起搏的研究

Study on left bundle branch pacing guided by contrast image guidance

目的探讨一种基于造影图像指导下的新的左束支起搏(LBBP)植入技术。方法选取内蒙古自治区人民医院2020年11月至2021年10月收治的40例有起搏器适应证的患者作为研究对象,其中20例患者行LBBP(LBBP组),另20例患者行传统右室心尖部起搏(RVP组),LBBP组在造影图像的精确指导方法下进行植入。记录2组患者标准12导联体表心电图,分别比较术前、LBBP及RVP时的QRS波时限,并选取植入时,术后1~3 d、3个月和术后1年随访时评估起搏参数和安全事件。结果术后LBBP组QRS波时限较术前变窄[(123.95±30.31)ms vs.(108.03±14.40)ms,P=0.043],RVP组QRS波时限较术前明显变宽[(108.00±13.76)ms vs.(132.15±13.27)ms,P<0.001]。植入时LBBP组的起搏阈值为0.70(0.50,0.98)V,RVP组为0.75(0.53,0.80)V,术后随访期间2组均保持较低且稳定的起搏阈值;经过1年随访,LBBP组R波振幅有所升高[9.80(7.05,14.80)mV vs.31.36(21.20,31.36)mV,P<0.001]。随访1年,2组均未发生不良事件。结论利用造影图像指导法指导LBBP是可行的。

Objective To explore a new technique of left bundle branch pacing(LBBP)implantation guided by contrast images.Methods A total of 40 patients with pacemaker indications in Inner Mongolia Au-tonomous Region People's Hospital from November 2020 to October 2021 were selected as the research objects.Among them,20 patients underwent left bundle branch pacing(LBBP group),and the other 20 patients underwent traditional right ventricular apical pacing(RVP group).The standard 12-lead electrocardiogram of two group was recorded.QRS duration was compared before operation,during left bundle branch pacing,and during right ventricular apical pacing.Pacing parameters and safety events of two group were evaluated at the time of implantation,one to three days after operation,three months,and one year after operation.Results After operation,the duration of QRS in the LBBP group was narrower than that before operation[(123.95±30.31)ms vs.(108.03±14.40)ms,P=0.043],and the QRS wave duration was significantly wider in the RVP group[(108.00±13.76)ms vs.(132.15±13.27)ms,P<0.001].At the time of the implantation,the pacing threshold was 0.70(0.50,0.98)V in the LBBP group and 0.75(0.53,0.80)V in the RVP group.Dur-ing postoperative follow-up,both groups maintained a low and stable pacing threshold.After one year of fol-low-up,R wave was increased in the LBBP group[9.80(7.05,14.80)mV vs.31.36(21.20,31.36)mV,P<0.001].No adverse events were observed in both groups during one year follow-up.Conclusion It is feasible to guide LBBP by contrast image guidance.