左束支区域起搏在房室传导阻滞并行永久性心脏起搏器植入术患者中的临床价值

Clinical value of left bundle branch pacing in patients with atrioventricular block and permanent cardiac pacemaker implantation

目的探讨左束支起搏(LBBP)在房室传导阻滞并行永久性心脏起搏器植入术患者中的临床价值。方法选择2020年1月至2022年6月九江市第一人民医院收治的50例房室传导阻滞行永久性心脏起搏器植入术患者,根据随机数字表法将其分为对照组和观察组,每组25例。对照组术中采用右心室低位间隔部起搏,观察组术中采用LBBP。观察两组起搏参数、心室房室同步性、心功能变化及不良预后发生情况。结果两组患者术后即刻、术后6个月的感知、阻抗及阈值参数比较,差异无统计学意义,且两组间比较差异无统计学意义(P>0.05);两组术后6个月的左心室充盈时间与RR间期比值(LVFT/RR)均低于本组术后即刻,且观察组低于对照组,差异有统计学意义(P<0.05);对照组术后即刻、术后6个月的QRS波时限比较,差异无统计学意义(P>0.05);观察组术后6个月的QRS波时限低于本组术后即刻及对照组,差异有统计学意义(P<0.05);两组术后6个月心功能分级均优于术前,且观察组优于对照组,差异有统计学意义(P<0.05);两组不良预后发生情况比较,差异无统计学意义(P>0.05)。结论LBBP能够减少对房室传导阻滞行永久性心脏起搏器植入术患者心功能的影响,有助于保持良好的机械同步性,改善患者预后。

Objective To explore the clinical value of left bundle branch pacing(LBBP)in patients with atrioventricular block and permanent cardiac pacemaker implantation.Methods A total of 50 patients with atrioventricular block who underwent permanent cardiac pacemaker implantation in Jiujiang NO.1 People's Hospital from January 2020 to June 2022 were selected.According to the random number table method,they were divided into control group and observation group,with 25 cases in each group.The control group was treated with right ventricular low septum pacing during operation,and the observation group was treated with LBBP during operation.The pacing parameters,ventricular atrioventricular synchrony,cardiac function changes and adverse prognosis were observed.Results There were no significant differences in perception,impedance and threshold parameters between the two groups immediately after operation and 6 months after operation,and there were no significant differences between the two groups(P>0.05).The left ventricular filling time to RR interval ratio(LVFT/RR)of the two groups 6 months after operation were lower than those immediately after operation,and observation group was lower than control group,and the differences were statistically significant(P<0.05).In the control group,there was no significant difference in QRS wave duration immediately after operation and 6 months after operation(P>0.05).The QRS wave duration of the observation group 6 months after operation was lower than that immediately after operation and that of the control group,and the difference was statistically significant(P<0.05).The cardiac function classification of the two groups 6 months after operation were better than those before operation,and observation group was better than control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse prognosis between the two groups(P>0.05).Conclusion LBBP can reduce the impact on cardiac function in patients with atrioventricular block undergoing permanent pacemaker implantation,help to maintain good mechanical synchrony,and improve the prognosis of patients.