缓慢性心律失常患者左束支区域起搏与右心室间隔部起搏的起搏参数稳定性对比研究

Comparative study on the stability of pacing parameters between left bundle branch pacing and right ventricular septum pacing in patients with bradyarrhythmia

目的比较缓慢性心律失常患者行左束支区域起搏(LBBP)与右心室间隔部起搏(RVSP)的起搏参数的稳定性。方法回顾性收集2019年1月至2022年8月在首都医科大学附属北京安贞医院接受心脏双腔永久起搏器植入术的缓慢性心律失常患者的临床资料,根据心室电极植入部位分为RVSP组(155例)和LBBP组(106例)。收集并比较2组基线临床资料,术后和1年随访时程控参数(心室感知、心室阈值、心室阻抗)。结果LBBP组的左心室舒张末期内径、左心室收缩末期内径大于RVSP组(均P=0.002)。2组患者病态窦房结综合征和房室传导阻滞比例比较差异均无统计学意义(均P>0.05)。术后,LBBP组QRS波宽度较RVSP组明显缩窄[(110±21)ms比(140±29)ms](t=8.204,P<0.001)。术后,2组心室感知比较差异无统计学意义(P=0.514),LBBP组心室阈值高于RVSP组[(0.86±0.33)V比(0.69±0.22)V],心室阻抗低于RVSP组[(734±200)Ω比(913±276)Ω],差异均有统计学意义(均P<0.001)。2组术后1年随访结果显示:LBBP组心室感知、心室阈值高于RVSP组,心室阻抗低于RVSP组,差异均有统计学意义(均P<0.05);LBBP组心室起搏比例高于RVSP组,但组间比较差异无统计学意义(P=0.064)。结论在永久起搏器植入的缓慢性心律失常患者中,RVSP与LBBP起搏参数均安全稳定,相比于RVSP,LBBP有利于维持良好的心脏收缩同步性。

Objective To compare the stability of pacing parameters between left bundle branch pacing(LBBP)and right ventricular septal pacing(RVSP)in patients with bradyarrhythmia.Methods The clinical data of patients with bradyarrhythmia who underwent implantation of permanent dual-chamber pacemaker in Beijing Anzhen Hospital,Capital Medical University from January 2019 to August 2022 were retrospectively collected.According to the ventricular lead implantation site,patients were divided into RVSP group(155 cases)and LBBP group(106 cases).The baseline clinical data and programmed parameters(ventricular sensing,ventricular threshold,ventricular impedance)were collected and compared between the two groups after operation and at 1-year follow-up.Results Left ventricular end diastolic diameter and left ventricular endsystolic diameter were larger in the LBBP group than those in the RVSP group(both P=0.002).There was no significant difference in the proportion of sick sinus syndrome and atrioventricular block between the two groups(both P>0.05).After operation,the QRS width in LBBP group was significantly narrower than that in RVSP group[(110±21)ms vs(140±29)ms](t=8.204,P<0.001).After operation,there was no significant difference in ventricular sensing between the two groups(P=0.514).The ventricular threshold in LBBP group was higher than that in RVSP group[(0.86±0.33)V vs(0.69±0.22)V],and the ventricular impedance was lower than that in RVSP group[(734±200)Ωvs(913±276)Ω].The differences were statistically significant(all P<0.001).The 1-year follow-up results of the two groups showed that the ventricular sensing and ventricular threshold in the LBBP group were higher than those in the RVSP group,and the ventricular impedance was lower than that in the RVSP group(all P<0.05).The proportion of ventricular pacing in LBBP group was higher than that in RVSP group,but there was no significant difference between the two groups(P=0.064).Conclusion In patients with bradyarrhythmia with permanent pacemaker implantation,RVSP and LBBP pacing parameters are safe and stable.Compared with RVSP,LBBP is beneficial to maintain good cardiac systolic synchrony.