左束支起搏对心室起搏依赖伴射血分数降低心力衰竭的长期疗效

Long-term effect of left bundle branch pacing on ventricular pacing dependence and heart failure with reduced ejection fraction

目的探讨在心室起搏依赖伴射血分数降低的心力衰竭(HFrEF)患者中行左束支起搏的可行性和长期疗效。方法本研究为前瞻性观察性研究,连续入选2019年1月至2021年12月在复旦大学附属中山医院心内科因心动过缓、预计心室起搏比例>40%且左心室射血分数<40%,行左束支起搏的患者。比较术前与术后QRS时限、起搏参数(阈值、感知和阻抗)、超声心动图参数的变化。结果共入选35例HFrEF患者,年龄(69.0±13.1)岁,其中男26例。左束支起搏成功率为100%。随访(2.6±0.7)年,患者术后QRS时限较术前趋于改善[(142.9±46.4)ms对(133.0±16.8)ms,P=0.088]。术中和术后随访相比,患者起搏阈值、感知和阻抗均差异无统计学意义(P>0.05)。术前和术后随访相比,患者左心室射血分数(34.2%±5.1%对44.7%±12.6%,P<0.0001)、左心室舒张末期内径[(62.7±12.2)mm对(58.3±11.9)mm,P=0.002]、左心室收缩末期内径[(52.5±11.7)mm对(47.5±13.4)mm,P=0.004]均显著改善,差异有统计学意义。结论左束支起搏在心室起搏依赖伴HFrEF患者中成功率高,术后长期随访起搏参数稳定,心功能显著改善。

Objective To explore the feasibility and long-term outcomes of left bundle branch pacing(LBBP)in patients with ventricular pacing dependence and heart failure with reduced ejection fraction(HFrEF).Methods This study was a prospective observational study.Patients indicated for LBBP due to bradycardia and an expected ventricular pacing ratio of>40%with a left ventricular ejection fraction of<40%in Department of Cardiology,Zhongshan Hospital,Fudan University between January 2019 and December 2021 were consecutively enrolled.The QRS duration,pacing parameters(thresholds,perception and impedance),and echocardiographic parameters were compared between baseline and during follow-up.Results A total of 35 HFrEF patients mean age(69.0±13.1)years,26 males,were enrolled,and all patients successfully underwent LBBP.The follow-up time was(2.6±0.7)years.The QRS duration trended towards improvement[(142.9±46.4)ms vs.(133.0±16.8)ms,P=0.088].Pacing parameters including thresholds,perception,and impedance all remained stable during follow-ups(P>0.05).Significant difference was observed in left ventricular ejection fraction(34.2%±5.1%vs.44.7%±12.6%,P<0.0001),left ventricular end-diastolic internal diameter[(62.7±12.2)mm vs.(58.3±11.9)mm,P=0.002],and left ventricular end-systolic internal diameter[(52.5±11.7)mm vs.(47.5±13.4)mm,P=0.004]between baseline and during follow-up.Conclusion LBBP has a high success rate in patients with ventricular pacing dependence and HErEF,with stable pacing parameters and significant improvement in cardiac function at long-term follow-up.