左束支区域不同部位起搏Ⅱ及V_(4)导联图形特征分析

Changes of leadⅡand V_4 patterns in pacing at different locations in the left bundle branch region

目的对比分析在左束支区域的不同部位进行左束支起搏(LBBP)后的心电图变化,探索左束支区域不同部位起搏后Ⅱ及V_(4)导联心电图的图形特征。方法选择2021年8月至2022年8月于内蒙古自治区人民医院行LBBP治疗的17例病窦综合征或房室传导阻滞且有起搏器适应证的成人患者,每例患者均在术中右前斜30°下进行右室造影,定位左束支分布区域,以大致左束支区域中心点进行长轴和短轴二等分,仅对左束支区域进行四分区,且LBBP成功后均把电极末端位置在影像轮廓内进行标记,搜集记录入院至术前、术中及术后3个月资料。术前、术中由锦江电子多导仪,术后由中旗iMAC1200心电图机进行12导联心电图数据收集,分析左束支不同部位固定电极起搏后即刻及术后3个月Ⅱ及V_(4)导联起搏图形移行变化即R>S、R<S分布占比。结果起搏位置在1+2区Ⅱ导联多为R>S[72%(8/11)],而在3+4区Ⅱ导联全部为R<S[100%(6/6)],在1+3区起搏位置从间隔高位到低位移行过程中Ⅱ导联S(s)波多逐渐加深[50%(5/10)],2+4区Ⅱ导联S(s)波多逐渐加深[57%(4/7)];在1+2区起搏位置从心底到心尖移行过程中V_(4)导联S(s)波均逐渐加深[64%(7/11)],3+4区V_(4)导联S(s)波多逐渐加深[83%(5/6)],起搏位置在2+4区胸导联V_(4)起搏图形多为R<S[71%(5/7)],而在1+3区胸导联V_(4)导联起搏图形以R>S[100%(10/10)]为主。结论LBBP心电图Ⅱ及V_(4)导联QRS波形态随着左束支区域不同部位起搏有不同的图形特征。

Objective To compare and analyze the electrocardiogram changes after left bundle branch pacing(LBBP)in different parts of the left bundle branch area,and to explore the graphic characteristics of leadⅡandⅤ_4electrocardiogram after pacing in different parts of the left bundle branch area.Method From August 2021 to August 2022,17 adult patients with sick sinus syndrome or atrioventricular block and pacemaker indications who were treated with LBBP in the People's Hospital of Inner Mongolia were selected.Each patient underwent right ventricle angiography at 30°of right anterior inclination during surgery to locate the distribution area of left bundle branch.The long axis and short axis were bisected by roughly the center point of left bundle branch area,and only the left bundle branch area was divided into four areas,After successful LBBP,the electrode end position was labeled within the image contour,and data from admission to surgery,during surgery,and 3 months after surgery were collected and recorded.Before and during surgery,12 lead electrocardiogram data was collected using Jinjiang Electronic Multiconductor,and after surgery,using Zhongqi iMAC1200 electrocardiograph.The distribution of R<S and R<S was analyzed for the changes in theⅡandⅤ_(4)lead pacing patterns immediately and 3 months after left bundle branch pacing.Result The pacing position in zone 1+2 leads was mostly R<S[72%(8/11)],while in zone 3+4 leads,all leads were R<S[100%(6/6)].During the transition from high to low intervals in zone 1+3pacing positions,the S(s)waves in zone 2+4 leads gradually deepened[50%(5/10)],and the S(s)waves in zone 2+4 leads gradually deepened[57%(4/7)];During the transition from the bottom to the apex of the heart at the pacing position in zone 1+2,the S(s)waves in lead V_(4)gradually deepened[64%(7/11)],while in zone 3+4,the S(s)waves in lead V_(4)gradually deepened[83%(5/6)].In zone 2+4,the pacing pattern in lead V_(4)was mostly R<S[71%(5/7)],while in zone 1+3,the pacing pattern in lead V4 was mainly R<S[100%(10/10)].Conclusion The morphology of LBBP electrocardiogramⅡandⅤ_(4)lead QR<S varies with pacing in different parts of the left bundle branch area.