慢性右心室起搏患者升级为左束支区域起搏后生活质量分析

Health-related guality of life after left bundle branch area pacing upgrade in patients of chronic right ventricular pacing

目的观察慢性长期右心室起搏患者升级为左束支区域起搏(LBBAP)后生活质量分析。方法选择2020年6月至2022年6月浙江大学附属邵逸夫医院住院患者,入选患者为长期右心室起搏(起搏比例≥40%)因电池耗竭或心衰住院欲升级为左束支区域起搏,并在术后3个月、12个月进行随访观察,比较起搏器升级前,术后3个月、12个月生活质量变化及心脏功能参数,生活质量变化采用以下3个问卷分析:健康SF-36量表,三水平五维度健康量表(EQ-5D-3L)及明尼苏达心功能不全问卷(MLHFQ)。结果25例患者符合标准入组,最终23个成功升级为LBBAP,并全部在术后12个月内完成了随访,在SF-36量表中,经过多时间段统计分析,23例患者分别在生理功能(P<0.001)、生理职能(P<0.001)、一般健康状态(P<0.001)、精力(P=0.005)、社会功能(P=0.006)、精神健康(P=0.002)6大领域得到了很大的改善,EQ-5D-3L总分(P=0.004)及MLHFQ评分(P<0.001)也比升级前有明显的提高,且治疗后12个月比治疗后3个月改善更明显,患者治疗前后脑利钠肽前体(ProBNP,P=0.004)、左室射血分数(LVEF,P<0.001)、左室收缩期容积(LVESV,P=0.001)比较也有显著改善。把23例患者进行分组,分析发现起搏介导心肌病(PICM)组患者(11/23),比非PICM组(12/23),生活质量改善更明显。结论长期右心室起搏患者升级为左束支区域起搏后可以提高患者生活质量,逆转心室重构,改善心脏功能,且PICM患者获益更显著。

Objevtive To determine the health-related quality of life(QOL)after left bundle branch area pacing(LBBAP)upgrade in patients after chronic long-term right ventricular pacing(RVP).Methods Patients(enrolled in the Sir Run Run Shaw Hospital from June,2020 to June,2022)referred for pulse generator change or heart failure with long-term RVP of larger than 40%attempted for LBBAP upgrade were included.Cardiovascular health and quality of life were measured by three sacles:36-Item Short-Form health survey(SF-36),Three-level version EQ-5D(EQ-5D-3L)and minnesota living with heart failure(MLHFQ).The datas were compared at baseline,3 months and 12 months after LBBAP.Results Permanent LBBAP upgrade was successful in 23 of twenty-five patients and were followed up for 12 months.After multitime period statistical analysis,Improvements in QOL parameters including physical functioning(P<0.001),role-physical(P<0.001),general health(P<0.001),vitality(P=0.005),Social role(P=0.006),and Mental health(P=0.002)on the MOS SF-36 Health Survey,Total scores of EQ-5D-3L(P=0.004)and MLHFQ(P<0.001)were all improved significantly during 12 months,and the improvements were more obvious in 12 months than in 3 months.After 12-month follow up,Parameters of Cardiac function including:N-terminal pro-B-type(Pro-BNP)(P=0.004),left ventricular ejection fraction(LVEF)(P<0.001)and left ventricular end of systolic volume(LVESV)(P=0.001)were all improvented significantly.Amony all patients,the improvement in QOL was greater in 11 patients(11/23)with pacing-induced cardiomyopathy(PICM)than those(12/23)withnot at 12-month follow-up.Conclusion The health-related QOL can be improved by LBBAP upgrade in patients by long term RVP.LBBAP can reverse electrical synchrony and structure remodeling by chronic RVP,patients with PICM benefit more.