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左束支不同部位起搏的临床特点分析

Analysis on clinical characteristics of pacing in different parts of left bundle branch
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摘要 目的研究左束支不同部位起搏对心电图QRS波时限、形态及起搏参数的影响。方法选取2020年3月至2022年10月该院符合起搏适应证并成功行左束支起搏(LBBP)的94例患者作为研究对象。根据起搏后的体表心电图形态,将受试者分成左束支主干起搏(LBTP)组与左束支分支起搏(LBFP)组,LBFP组再细分为左后分支起搏(LPFP)组与左前分支起搏(LAFP)组。记录各组起搏后心电图QRS波的时限、形态,术中、术后3个月的起搏参数(包括起搏阈值、电极感知、电极阻抗),术前、术后3个月的血B型钠尿肽(BNP)水平。观察各组患者术中及术后并发症发生情况。结果LBTP组起搏后QRS波时限(103.91±7.86)ms低于LBFP组的(108.43±8.72)ms,差异有统计学意义(P<0.05),而LPFP组起搏后QRS波时限(108.51±8.93)ms与LAFP组(108.29±8.51)ms比较差异无统计学意义(P>0.05)。起搏后V1导联QRS波形态分布以Qr型为主,各组间比较差异无统计学意义(P>0.05)。LBTP组与LBFP组、LPFP组与LAFP组术中和术后3个月起搏阈值、电极感知、电极阻抗比较差异无统计学意义(P>0.05)。LBTP组与LBFP组术前和术后3个月BNP水平比较差异无统计学意义(P>0.05)。结论LBTP在心室电同步性方便优于LBFP,两者术中和术后3个月起搏参数均较理想。 Objective To study the effects of pacing at different parts of left bundle branch on the duration,morphology and pacing parameters of QRS wave in electrocardiogram.Methods Ninety-four patients with successful left bundle branch pacing(LBBP)conforming to the pacing indication in this hospital from March 2020 to October 2022 were selected as the study subjects.They were divided into the left bundle trunk pacing(LBTP)and left bundle fascicular pacing(LBFP)group according to the body surface ECG morphology,and the LBFP group was subdivided into the left posterior fascicle pacing(LPFP)group and left anterior fascicle pacing(LAFP)group.The duration and shape of ECG QRS wave after pacing and pacing parameters(including pace-making threshold value,selctrode perception and electrode impedance)during the operation and in 3 months after operation,blood BNP levels before operation and in postoperative 3 months were recorded in each group.The complications occurrence situation during operation and after operation were observed in each group.Results The QRS duration after pacing in the LBTP group was significantly lower than that in the LBFP group[(103.91±7.86)ms vs.(108.43±8.72)ms,P<0.05],and the difference was statistically significant(P>0.05),while the QRS duration after pacing between the LBTP group and LAFP group had no statistical difference[(108.51±8.93)ms vs.(108.29±8.51)ms,P>0.05].The QRS morphologies distribution in the lead V1 after pacing was mainly the Qr pattern,and there was no statistically significant differences among the groups(P>0.05).There were no statistically significant differences in the pacing threshold value,electrode perception and electrode impedance during operation and in postoperative 3 months between LBTP and LBFP group,and LPFP group and LAFP group(P>0.05).There were no statistically significant difference in the BNP level before operation and in postoperative 3 months between the LBTP group and LBFP group(P>0.05).Conclusion LBTP is superior to LBFP in the aspect of ventricular electrical synchronization,and the pacing parameters of the both are ideal during operation and in postoperative 3 months.
作者 乔建忠 张斌 汪杰 潘令新 熊恩来 QIAO Jianzhong;ZHANG Bin;WANG Jie;PAN Lingxin;XIONG Enlai(Department of Cardiovascular Internal Medicine,Tongling Municipal People’s Hospital,Tongling,Anhui 244000,China)
出处 《重庆医学》 CAS 2023年第22期3455-3459,3464,共6页 Chongqing medicine
基金 安徽省铜陵市卫生健康委员会医学科研项目[卫科研(2021)7号]。
关键词 左束支主干起搏 左束支分支起搏 QRS波时限 QRS波形态 起搏参数 left bundle trunk pacing left bundle fascicular pacing QRS duration QRS morphology pacing parameters
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  • 1中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会,黄伟剑,黄德嘉,张澍,陈柯萍,陈学颖,戴研,侯小锋,华伟,梁延春,刘兴斌,苏蓝,宿燕岗,邹建刚.希氏-浦肯野系统起搏中国专家共识[J].中华心律失常学杂志,2021,25(1):10-36. 被引量:83

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