左束支区域起搏治疗缓慢性心律失常患者临床有效性及安全性评估

Clinical efficacy and safety of left bundle branch area pacing in bradyarrhythmia patients

目的评估左束支区域起搏(LBBP)治疗缓慢性心律失常(BA)患者的有效性及安全性。方法将82例BA患者按照起搏器植入位置不同分成LBBP组41例、右室间隔起搏(RVSP)组41例,两组患者均行常规心脏检查。分别于术前及术后6个月观察两组患者BA症状和心率,并评估手术有效性,应用起搏器程控仪测定起搏参数,采用超声检查心功能,使用中国心血管病人生活质量评定问卷(CQQC)评估生活质量,记录并发症发生情况。比较两组患者临床疗效、起搏参数、心功能、生活质量及并发症。结果LBBP组患者临床疗效总有效率高于RVSP组(P<0.05)。两组患者心室感知、阈值及阻抗在组间效应、时间效应、交互效应比较,差异均无统计学意义(P>0.05)。术后6个月,LBBP组患者RVEDV、RVESV均升高,RVEF、RVFAC均降低,且RVEDV、RVESV均高于RVSP组,RVEF、RVFAC均低于RVSP组(P<0.05或0.01)。两组患者CQQC各维度评分均较术前升高,且LBBP组高于RVSP组(P<0.05或0.01)。在随访期间,两组患者均未出现并发症。结论LBBP对应用永久性心脏起搏器植入的BA患者有良好的治疗作用,保持稳定的起搏参数,保护心功能,安全性良好,有助于提高患者生活质量。

Objective To evaluate the effectiveness and safety of left bundle branch area pacing(LBBP)in the treatment of bradyarrhythmias(BA)patients.Methods Eighty-two BA patients were divided into LBBP(n=41)and right ventricular septal pacing(RVSP,n=41)group according to pacemaker implantation location,routine cardiac examinations performed in both groups.Before and 6 months after operation BA symptoms and heart rates were observed for both groups,surgical effectiveness was assessed,pacing parameters were measured by pacemaker programmer,cardiac function was examined by ultrasound,quality of life was assessed by the China Questionnaire of Quality of Life in Patients with Cardiovascular Diseases(CQQC),and the occurrence of complications recorded.Such indexes were compared between two groups as clinical efficacy,pacing parameters,cardiac function,quality of life,and complications.Results The clinical total effective rate was higher in LBBP than RVSP group(P<0.05).Intergroup differences in intergroup effect,time effect and interaction effect of ventricular perception,threshold and impedance weren't statistically significant(P>0.05).Six months after operation,right ventricular end diastolic volume(RVEDV)and right ventricular end systolic volume(RVESV)elevated,right ventricular ejection fraction(RVEF)and right ventricular fractional area change(RVFAC)lowered in LBBP group,and the RVEDV and RVESV were higher and RVEF and RVFAC lower than those in RVSP group(P<0.05 or 0.01).Postoperative CQQC scores elevated in both groups compared with pre-operation and that was higher in LBBP than RVSP group(P<0.05 or0.01).No complications occurred in both groups during follow-up.Conclusion LBBP has a good therapeutic effect on BA patients with permanent pacemaker implantation,maintains stable pacing parameters,protects cardiac function,has good safety,and is helpful to the improvement of patients'quality of life.