瓣环造影方法指导犬类动物传导系统起搏的可行性研究

Feasibility of tricuspid valve annulus angiography for conduction system pacing in canine models

目的探讨瓣环造影方法指导比格犬传导系统起搏(CSP)的可行性研究。方法选取6只成年比格犬(12~15 kg,雌雄不限)均使用双主动固定导线实施CSP。首先在右前斜30°影像下通过瓣环造影显示三尖瓣瓣环和右心室游离壁。将希氏束鞘管和其中1根主动固定导线送入三尖瓣膈瓣下方区域实施希氏束远端起搏(DHBP);之后,对于其中3只犬,利用造影显示的三尖瓣环顶端、两侧右心室游离壁中点这3个点形成的三角区域,将另外1根主动固定导线送入该三角中心位置实施左间隔支起搏(LSFP);另外3只犬,平行于该三角底边方向移动鞘管至三角左侧线位置实施左后分支起搏(LPFP)。术中收集12导联心电图、腔内心电图、束支电位、起搏阈值、R波感知等主要心电和起搏参数数据,术后通过5%卢戈碘染色法取材判断导线的最终位置是否与影像位置符合。结果所有比格犬均成功实施CSP,心电图符合CSP夺获的标准。进一步分析显示,LSFP和LPFP犬的P电位到V波间期[(11.33±0.58)ms对(11.00±1.00)ms,P=0.643]、V_(6)导联达峰时间[(36.67±1.53)ms对(34.67±4.04)ms,P=0.468]和起搏QRS时限[(68.33±3.21)ms对(63.00±4.58)ms,P=0.174]比较,差异均无统计学意义;起搏参数比较,差异亦无统计学意义。5只犬术中出现一过性右束支损伤,均为实施DHBP过程中发生。其中2只犬最后发展为永久性右束支传导阻滞。无一只实验犬出现急性期导线脱位、随访期间导线脱位或穿孔等并发症。所有犬取材后通过传导系统染色,提示导线的最终位置与术中影像位置基本符合。结论三尖瓣环造影方法有助于指导比格犬类动物实施DHBP、LSFP和LPFP,其建模安全有效,易于推广。

ObjectiveTo explore the feasibility of tricuspid valve annulus(TVA)angiography in guiding conduction system pacing(CSP)in Beagles.MethodsSix adult beagles(12-15 kg,male or female animals)underwent TVA angiography using dual dual pacing lead(3830)under the right anterior oblique(RAO)30°.The His sheath with pacing lead was moved nearby the tricuspid septal to map HB potential for distal His-bundle pacing(DHBP).A"triangle zone"was drawn from the TVA summit,right and left midpoints of the right ventricular free-wall.For 3 beagles,the"triangle-center"was intended as the target lead screwing position for left septal fascicle pacing(LSFP).For another 3 beagles,move the sheath parallel to the bottom of the"triangle-center"to the left line of this triangle to perform left posterior fascicle pacing(LPFP).Twelve-lead electrocardiogram,intra-cardiac electrogram,Purkinje potential,pacing threshold and R-wave amplitude etc.were collected.Five percent Lugo iodine staining method was used for determining whether the final position of the pacing lead matches the imaging position during the procedure.ResultsAll beagles successfully underwent CSP,and the electrocardiogram met the guideline criteria for CSP capture.Subgroup analysis showed that there were no significant difference in P-V interval[(11.33±0.58)ms vs.(11.00±1.00)ms,P=0.643],V 6 R-wave peak time[(36.67±1.53)ms vs.(34.67±4.04)ms,P=0.468]and paced QRS duration[(68.33±3.21)ms vs.(63.00±4.58)ms,P=0.174]between LSFP and LPFP.There were also no significant difference in pacing parameters between the two pacing modality.Transient right bundle branch injury occurred in 5 dogs during the implementation of DHBP.Two dogs eventually developed permanent right bundle branch block.No lead-related complications were observed during the follow-up.Purkinje conduction system components in left ventricular endocardium were dyed using 5%Lugol iodine,indicating that the final position of the lead was consistent with the imaging position during the procedure.ConclusionThe TVA angiography approach was useful for implement DHBP,LSFP and LPFP,demonstrating its safety,effective and easiness to promote.