左束支是否夺获对房室传导阻滞患者心脏收缩功能的影响

Impact of left bundle branch capture on cardiac function in patients with atrioventricular block

目的探讨左束支夺获与否对房室传导阻滞患者心脏收缩功能的影响。方法本研究为回顾性队列研究。入选左束支起搏(LBBP)和左心室间隔部起搏(LVSP)患者基线和末次随访的超声心动图等资料,所有患者随访时间≥6个月且心室起搏比例≥20%。对比两组患者左心室内径和左心室射血分数(LVEF)等指标。结果共入组71例患者,男37例,年龄(67.6±12.2)岁,根据术中资料判断有无左束支夺获分为LBBP组(51例)和LVSP组(20例)。心室起搏比例为91.6%±17.5%。LBBP组单极3.0 V/0.5 ms起搏下的左心室达峰时间(LVAT)明显短于LVSP组[(71.3±9.3)ms对(82.2±9.7)ms,P<0.001],LBBP组起搏QRS时限明显窄于LVSP组[(140.1±17.6)ms对(151.0±21.7)ms,P=0.031]。随访(22.3±15.8)个月,LBBP组患者LVEF较基线无明显改变;LVSP组患者LVEF较基线下降(63.0%±4.3%对59.4%±7.1%,P=0.044),差异有统计学意义。LBBP组的LVEF改变值(-0.3%±4.2%对-3.6%±7.5%,P=0.021)和左心室收缩末期内径(LVESD)改变值[(-1.6±3.2)mm对(0.4±3.8)mm,P=0.031]明显优于LVSP组。LBBP组和LVSP组中分别有1例和3例患者LVEF下降超过10%且最终LVEF≤50%,其中LVSP组的1例患者死于心力衰竭。结论对于心功能正常的患者,LBBP可以有效保护心脏收缩功能,而LVSP可引起心室收缩能力下降。

Objective To explore the impact of left bundle branch capture on cardiac systolic function in patients with atrioventricular block.Methods The study was a retrospective cohort study.The baseline and follow-up echocardiographic data of patients undergoing left bundle branch pacing(LBBP)and left ventricular septal pacing(LVSP)were retrospectively collected.All patients had a follow-up period of≥six months and a ventricular pacing percentage of≥20%.Left ventricular diameters and left ventricular ejection fraction(LVEF)were compared between LBBP and LVSP patients.Results A total of 71 patients were enrolled with 35 males and an average age of(67.6±12.2)years.Based on procedural data,patients were divided into LBBP group(51 cases)and LVSP group(20 cases).The average percentage of ventricular pacing was 91.6%±17.5%.Under unipolar pacing at 3.0 V/0.5 ms,the left ventricular activation time(LVAT)in the LBBP group was significantly shorter than that in the LVSP group[(71.3±9.3)ms vs.(82.2±9.7)ms,P<0.001].The paced QRS duration in LBBP group was significantly shorter than that in LVSP group[(140.1±17.6)ms vs.(151.0±21.7)ms,P=0.031].Over an average follow-up of(22.3±15.8)months,the LBBP group showed no significant change in LVEF from baseline,while the LVSP group showed a significant decrease in LVEF(63.0%±4.3%vs.59.4%±7.1%,P=0.044).The change in LVEF in the LBBP group was(-0.3%±4.2%vs.-3.6%±7.5%,P=0.021)and left ventricular end-systolic diameter(LVESD)in the LBBP group was[(-1.6±3.2)mm vs.(0.4±3.8)mm,P=0.031]better than that in the LVSP group.In the LBBP and LVSP groups,1 and 3 patients,respectively,had a decrease in LVEF of more than 10%with a final LVEF≤50%.One patient in the LVSP group died of heart failure.Conclusion For patients with normal baseline cardiac function,LBBP can effectively preserve cardiac systolic function,whereas LVSP may cause decreased systolic function.