九分区法左束支区域起搏临床应用的单中心经验

Safety and feasibility of left Bundle branch area pacing via nine partition method in a single center

目的评估九分区法左束支区域起搏(LBBaP)方法的可行性、有效性和安全性。方法回顾性分析2020年6月至2021年12月在泰达国际心血管病医院拟行九分区法LBBaP的患者。收集临床基线资料包括既往病史、QRS波时限、超声心动图。根据手术报告记录术中有无束支电位;左室达峰时间(Sti-LVAT);手术时长,心室导线起搏阈值、感知及阻抗。通过门诊电子病历系统记录患者术后相关并发症,记录随访期间心室阈值、R波振幅、阻抗。按照术中Sti-LVAT是否≤80 ms分为左束支起搏(LBBP)组和左室间隔部起搏(LVSP)组,比较两组心室导线的起搏阈值、感知和阻抗。结果共纳入285例,263例成功行LBBaP,成功率为92.2%,其中男性148例(56.2%),年龄(63.4±9.1)岁,手术时长为(53.2±16.5)min,术后起搏QRS波时限为(115.4±18.1)ms。53例(20.2%)患者术中Sti-LVAT≥80 ms,为LVSP;210例(79.8%)Sti-LVAT<80 ms,为LBBP。术后12个月时心室导线的起搏阈值和感知均明显高于术中植入时,阈值均<1.5 V,导线阻抗明显低于术中植入时,并且趋于稳定,与术后24个月相关参数比较差异无统计学意义。与LBBP组相比,LVSP组Sti-LVAT[(67.9±7.1)ms,(84.0±3.1)ms]、自身QRS波时限[(94.3±16.7)ms,(110.4±19.7)ms]、起搏QRS波时限[(112.1±12.4)ms,(123.2±12.2)ms]更长(P均<0.05)。术后共10例出现手术相关并发症,并发症发生率3.8%。结论九分区法LBBaP降低了手术难度、简化了手术流程、成功率高,具有可行性,手术相关并发症发生率较低、随访期间导线参数稳定。

Objective To acess the feasibility,efficacy and safety of the nine-patition pacing method.Methods Retrospectively analysis of 285 patients received pacemaker from June 2020 to December 2021 in TEDA International Cardiovascular Hospital.Clinical data were collected from baseline data including past medical history,QRS interval,and echocardiogram.Record the intra-operative bundle branch potential according to the surgical report;Left ventricular peak time(stimulus to LV activation time);procedure duration,electrode parameters.Relevant postoperative complications were recorded through the outpatient electronic medical record system,and the ventricular threshold,R-wave amplitude,and impedance were recorded during the follow-up.According to whether the intra-operative LV peak reaching time was 80 ms,it was divided into left bundle branch pacing(LBBP)group and LV septal pacing(LVSP)group.The pacing threshold,perception and impedance of the two ventricular leads were compared.Results 263 patients successfully performed left bundle branch area pacing(LBBaP)with a success rate of 92.2%,including 148 males(56.2%),with a mean age of(63.4±9.1)years,operation duration of(53.2±16.5)min,and(115.4±18.1)ms of postoperative pacing QRS interval.53(20.2%)patients had Sti-LVAT≥80 ms for LV septal pacing;210(79.8%)patients had Sti-LVAT<80 ms for LBBaP.The pacing threshold and perception of ventricular lead at 12 months were significantly higher than that of intraoperative implantation,and the threshold was<1.5 V,and the lead impedance was significantly lower than that of intraoperative implantation,and became stable,and there was no statistical difference compared with the relevant parameters at 24 months after surgery.Compared with the LBBP group,the LVSP group with Sti-LVAT[(67.9±7.1)ms,(84.0±3.1)ms],intrinsic QRS interval[(94.3±16.7)ms,(110.4±19.7)ms],and pacing QRS interval[(112.1±12.4)ms,(123.2±12.2)ms]were longer,and the difference was statistically significant.A total of 10patients experienced procedure-related complications,with a complication rate of 3.8%.Conclusion Nine partition pacing method,which reduced the difficulty,simplified the procedure,has high success rate,feasibility,low incidence of operation-related complications,and stable lead parameters during follow-up.