The Impact of Cardiac Pacing Site on Patient's Cardiac Function and Psychological State

With the widespread application of artificial permanent pacemakers in clinical practice,there have been new changes in the indications for pacemaker implantation.The current clinical indications include high atrioventricular block,sick sinus syndrome,cardiac resynchronization therapy for heart failure,and implantation of cardioverter defibrillators for ventricular arrhythmias.The implantation of a pacemaker can improve the quality of life and prognosis of patients with arrhythmia.In the past,permanent pacemaker implantation was performed in clinical practice,and the right ventricular pacing electrode was often fixed at the apex of the right ventricle,which belongs to non physiological pacing.Through long-term clinical follow-up,it was found that apex pacing can easily cause abnormal depolarization of the left ventricle,asynchronous contraction of the myocardium,and ultimately lead to myocardial fibrosis,which has adverse effects on the patient's cardiac function and psychological state.In recent years,Scholars have found that pacing in the right ventricular outflow tract septum is closer to the atrioventricular node and closer to the His bundle Purkinje fibers.The pacing impulse almost simultaneously expands towards both ventricles,closer to the physiological pacing state,thereby reducing the occurrence of cardiovascular events in patients.This article explores the impact of pacing in different parts of the heart on the cardiac function and psychological state of patients based on clinical data from the past three years.

Integration of Digital Twins and Artificial Intelligence for Classifying Cardiac Ischemia

Despite advances in intelligent medical care,difficulties remain.Due to its complicated governance,designing,planning,improving,and managing the cardiac system remains difficult.Oversight,including intelligent monitoring,feedback systems,and management practises,is unsuccessful.Current platforms cannot deliver lifelong personal health management services.Insufficient accuracy in patient crisis warning programmes.No frequent,direct interaction between healthcare workers and patients is visible.Physical medical systems and intelligent information systems are not integrated.This study introduces the Advanced Cardiac Twin(ACT)model integrated with Artificial Neural Network(ANN)to handle real-time monitoring,decision-making,and crisis prediction.THINGSPEAK is used to create an IoT platform that accepts patient sensor data.Importing these data sets into MATLAB allows display and analysis.A myocardial ischemia research examined Health Condition Tracking’s(HCT’s)potential.In the case study,75%of the training sets(Xt),15%of the verified data,and 10%of the test data were used.Training set feature values(Xt)were given with the data.Training,Validation,and Testing accuracy rates were 99.9%,99.9%,and 99.9%,respectively.General research accuracy was 99.9%.The proposed HCT system and Artificial Neural Network(ANN)model gather historical and real-time data to manage and anticipate cardiac issues.

In vivo mechanical study of helical cardiac pacing electrode interacting with canine myocardium

Cardiac pacing is a medical device to help human to overcome arrhythmia and to recover the regular beats of heart. A helical configuration of electrode tip is a new type of cardiac pacing lead distal tip. The helical electrode attaches itself to the desired site of heart by screwing its helical tip into the myocardium. In vivo experiments on anesthetized dogs were carried out to measure the acute interactions between helical electrode and myocardium during screw-in and pull-out processes. These data would be helpful for electrode tip design and electrode/myocardium adherence safety evaluation. They also provide reliability data for clinical site choice of human heart to implant and to fix the pacing lead. A special design of the helical tip using strain gauges is instrumented for the measurement of the screw-in and pull-out forces. We obtained the data of screw-in torques and pull-out forces for five different types of helical electrodes at nine designed sites on ten canine hearts. The results indicate that the screw-in torques increased steplike while the torque-time curves presente saw-tooth fashion. The maximum torque has a range of 0.3-1.9 Nmm. Obvious differences are observed for different types of helical tips and for different test sites. Large pull-out forces are frequently obtained at epicardium of left ventricle and right ventricle lateral wall, and the forces obtained at right ventricle apex and outflow tract of right ventricle are normally small. The differences in pull-out forces are dictated by the geometrical configuration of helix and regional structures of heart muscle.

Future easy and physiological cardiac pacing

The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.

An Artificial Heart System for Testing and Evaluation of Cardiac Pacemakers

The usability assessment of a pacemaker is a complex task where the dedicated programmer for testing programmed algorithms is necessary.This paper provides the outcomes of development and complex testing of the artificial cardiac system to evaluate the pacemaker’s functionality.In this work,we used the modular laboratory platform ELVIS II and created graphical user interface in LabVIEW programming environment.The electrical model of the heart allows signals generation(right atrium,right ventricle)and the monitoring of the stimulation pulses.The LabVIEW user interface allows to set the parameters of the generated signals and the simulation of the cardiac rhythm disorders as well as the monitoring and visualization of the pacemaker behavior in real-time.The results demonstrate the capability of proposed system to evaluate the paced and sensed pulses.The proposed solution allows the scientists to test the behavior of any cardiac pacemaker for its pre-programmed settings and pacing mode.In addition,the proposed system can simulate various disorders and test cardiac pacemakers in different working modes.

THE OPERATION AND FEELINGS OF APPLICATION OF TEMPORARY CARDIAC PACING BESIDE BED WITHOUT FLUOROSCOPY

The endocardial electrodes were placed in endoventriculus beside bed withoutfluoroscopy in 9 patients who required temporary cardiac pacing and theresults were satisfactory.The manipulatory points are below:operatingcarefully with lightly and softly handling,noticing hand’s feeling,tryingagain by roling the electrode and/or changing its top’s direction whenmeeting with venous valves or branches.Judging the position of electrode’stop according to the right ventricular luminal electrogram.As comparedwith the setting of electrode under X ray,our method is superior in savingtime and requires less instrumente,the patients needn’t be moved,bothphysicans and patients are avoided X radiation’s injury.

Role of artificial intelligence in cardiology

Artificial intelligence(AI)is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes.AI is a rapidly evolving transdisciplinary field which integrates many elements to develop algorithms that aim to simulate human intuition,decision-making,and object recognition.The overarching aims of AI in cardiovascular medicine are threefold:To optimize patient care,improve efficiency,and improve clinical outcomes.In cardiology,there has been a growth in the potential sources of new patient data,as well as advances in investigations and therapies,which position the field well to uniquely benefit from AI.In this editorial,we highlight some of the main research priorities currently and where the next steps are heading us.

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.

Effects of atrial septal defects on the cardiac conduction system

The case report presented in this edition by Mu et al.The report presents a case of atrial septal defect(ASD)associated with electrocardiographic changes,noting that the crochetage sign resolved after Selective His Bundle Pacing(S-HBP)without requiring surgical closure.The mechanisms behind the appearance and resolution of the crochetage sign remain unclear.The authors observed the dis-appearance of the crochetage sign post-S-HBP,suggesting a possible correlation between these specific R waves and the cardiac conduction system.This editorial aims to explore various types of ASD and their relationship with the cardiac con-duction system,highlighting the diagnostic significance of the crochetage sign in ASD.

Predictors of super-response to cardiac resynchronization therapy： the significance of heart failure medication, pre-implant left ventricular geometry and high percentage of biventricular pacing

Background Super-responders （SRs） are defined as patients who show crucial cardiac function improvement after cardiac resynchro- nization therapy （CRT）. The purpose of this study is to identify and validate predictors of SRs after CRT. Methods This study enrolled 201 patients who underwent CRT during the period from 2010 to 2014. Clinical and echocardiographic evaluations were conducted before CRT and 6 months after. Patients with a decrease in New York Heart Association （NYHA） fimctional class 〉 1, a decrease in left ventricular end-systolic volume （LVESV） ≥ 15%, and a final left ventricular ejection fraction （LVEF） ≥ 45% were classified as SRs. Results 29% of the 201 patients who underwent CRT were identified as SRs. At baseline, SRs had significantly smaller left atrial diameter （LAD）, LVESV, left ventricular end-diastolic volume （LVEDV） and higher LVEF than the non-super-responders （non-SRs）. The percentage of patients using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ACEI/ARB） was higher in SRs than non-SRs. Most SRs had Biventricular （BiV） pacing percentage greater than 98% six months after CRT. In the multivariate logistic regression analysis, the independ- ent predictors of SRs were lower LVEDV [odd ratios （OR）： 0.93; confidence intervals （CI）： 0.90-0.97], use of ACEI/ARB （OR： 0.33; CI： 0.13~3.82） and BiV pacing percentage greater than 98% （OR： 0.29; CI： 0.16~.87）. Conclusion Patients with a better compliance of ACEI/ARB and a less ectatic ventricular geometry before CRT tends to have a greater probability of becoming SRs. Higher percentage of BiV pacing is essential for becoming SRs.

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

Objective To evaluate left univentricular （LUV） pacing for cardiac resynchronization therapy （CRT） using a rate-adaptive atrioven- tricular delay （RAAVD） algorithm to track physiological atrioventricular delay （AVD）. Methods A total of 72 patients with congestive heart failure （CHF） were randomized to RAAVD LUV pacing versus standard biventricular （BiV） pacing in a 1 ： 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V （right atrio-LV） delay using an RAAVD algorithm were compared. The standard deviation （SD） of the S/R ratio in lead VI at five heart rate （HR） segments （Rs/R-SD5）, defined as the ＂tracking index,＂ was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD. Results TheQRS complex duration （132 ± 9.8 vs. 138± 10ms, P 〈 0.05）, the time required for optimization （21 ±5 vs. 50±8min, P〈 0.001）, the mitral regurgitant area （1.9 ± 1.1 vs. 2.5 ± 1.3 em2, P 〈 0.05）, the interventricular mechanical delay time （60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P 〈 0.05）, and the average annual cost （13,200 ± 1000 vs. 21,600 ± 2000 RMB, P 〈 0.001） in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group （22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P 〈 0.05）. The Rs/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction （LVEF） （ALVEF, Pearson＇s r = -0.427, P = 0.009）, and positively correlated with New York Heart Association class （Spearman＇s r - 0.348, P 0.037）. Conclusions RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can de- crease the average annual cost of CRT.

Cardiac Resynchronization Therapy in Heart Failure in Sub-Saharan Africa Environment: Experience of the Principal Hospital of Dakar (Senegal)

Background: Heart failure is a major public health challenge in sub-Saharan Africa. In patients with chronic Heart Failure and cardiac desynchrony, studies have suggested that cardiac resynchronization, can improve cardiac function and the quality of life of patients. However, in Sub-Saharan Africa, very few studies have been done on cardiac resynchronization which is in its infancy. The aim of this study is to report the local data from our hospital. Method: It was a transversal, descriptive and analytical study conducted from November 2019 to September 2022 at the Cardiology Department of the Principal Hospital of Dakar. Results: Twelve patients were implanted for Cardiac Resynchronization Therapy (CRT). The sex ratio was 8 males/4 females. The average age was 67 ± 11 years. Ten patients had non-ischemic heart disease and the two others had ischemic one. All of them had NYHA III or IV scores before CRT. The Quality of Life (QOL) was judged as poor by all of the patients. The average duration of QRS was 156 ± 9 ms. 27.9% ± 5% was the mean Left Ventricular ejection fraction (LVEF). Complications occur in 3/12 patients (25%). It was one CS vein dissection, one micro LV lead dislodgement and one phrenic nerve stimulation. Nine patients, who were considered as responders, had an improvement of QOL and NYHA, the LVEF increased and the end-diastolic dimension, and the duration of the QRS interval all decreased. Two patients do not respond and one (1) who had permanent atrial fibrillation, was a secondary responder after an atrioventricular junction ablation. Conclusion: Cardiac resynchronization is a therapy that improves the QOL of patients, the LVEF and reduces the duration of the QRS interval. However, this procedure is not without risk of complications. In sub-Saharan Africa, the major challenge is to improve the financial accessibility of this therapy for the population.

希氏束起搏与右心室心尖部起搏对房室传导阻滞患者心脏结构学参数与功能学参数影响的临床研究

目的:探究希氏束起搏(HBP)与右心室心尖部起搏(RVAP)对房室传导阻滞(AVB)患者心脏结构学参数与功能学参数的影响。方法:选取收治的104例AVB患者为研究对象,随机分为HBP组和RVAP组各52例,HBP组行HBP治疗,RVAP组行RVAP治疗,比较两组术前、术后心脏结构学参数、心脏起搏参数、心率和血流动力学参数[心率(HR)、每搏输出量(SV)、心脏指数(CI)和左室射血分数(LVEF)]及QRS时限变化情况。结果:两组手术前后心脏结构学参数左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)比较,差异均无统计学意义(均P>0.05);术中、术后1个月、术后6个月心脏起搏阈值、R波幅度、电极阻抗比较无统计学差异(均P>0.05);术前、术后1个月,两组HR、SV、CI、LVEF、QRS时限比较无统计学差异(均P>0.05);术后6个月,HBP组HR、SV、CI、LVEF显著高于RVAP组(均P<0.05),RVAP组QRS波时限显著低于HBP组(P<0.05);结论:HBP对AVB患者的电-机械同步性优于RVAP,近期心脏血流动力学及心功能稳定性良好。

希浦系统起搏在CRT中的应用

1958年胸外科医生Senning为完全性房室传导阻滞患者植入了世界上首例埋藏式心脏起搏器,经过60余年的发展,从最初的右心室单腔起搏,到现在的双腔、三腔起搏,起搏器的风向标已经从单纯的激动心腔演变为追求电和机械同步性更佳的生理性起搏,应用范围也逐渐扩大,目前生理性起搏多采用希浦系统起搏。从最初的病态窦房结综合征、房室传导阻滞(atrioventricular block,AVB)等到现在的心脏再同步化治疗(cardiac resynchronization therapy,CRT),CRT可使用心脏再同步治疗起搏器(cardiac resynchronization therapy pacemaker,CRT-P)或心脏再同步治疗除颤器(cardiac resynchronization therapy defibrillator,CRT-D)。本文主要针对希浦系统起搏在CRT中的应用进行综述。

MRI人工智能辅助压缩感知心脏电影序列在心功能评估中的应用价值

目的探讨MRI人工智能辅助压缩感知(ACS)心脏电影(cine)序列在心功能评估中的应用价值。方法本研究连续纳入2022年5月至12月在我院行心脏MRI检查的63例受检者。所有受检者均进行常规cine和ACS-cine两种序列扫描,采用5分法进行图像质量评价。应用Wilcoxon符号秩检验对2种心脏cine序列的扫描时间、图像质量评分及心室功能定量参数进行比较。采用Spearman相关分析和BlandAltman分析评价两种序列测量心室功能定量参数的相关性和一致性。结果常规cine与ACS-cine序列扫描时间差异具有统计学意义(Z=-6.904,P<0.001),后者可将扫描时间大幅缩短约92.82%。常规cine与ACS-cine序列图像质量评分差异无统计学意义(Z=-0.816,P>0.05)。在心功能定量参数评估方面,常规cine与ACS-cine序列之间的LVEF、LVESV、RVEF、RVEDV、RVESV参数差异无统计学意义(P均>0.05),但LVEDV参数存在统计学差异(Z=-2.958,P<0.05)。常规cine与ACS-cine序列之间的心功能定量参数(LVEF、LVEDV、LVESV、RVEF、RVEDV、RVESV)均有良好的相关性(r=0.865~0.963,P均<0.01)。Bland-Altman分析显示,常规cine与ACS-cine序列图像获取的左心室及右心室功能定量参数(LVEF、LVEDV、LVESV、RVEF、RVEDV、RVESV)平均差异均接近于零,且变异范围很小,一致性高。结论相较于常规cine序列,ACS-cine序列能显著缩短成像时间的同时保证图像质量,并可准确分析左心室及右心室功能定量参数,具有较高的临床应用价值。

人工智能技术在PCI术后患者随访中的应用

目的探讨基于人工智能技术的经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者随访方案的应用效果。方法通过文献回顾、专家函询构建PCI术后人工智能随访方案。选取2022年10月至2023年11月于南昌大学第二附属医院行PCI的冠心病患者82例,根据随机数字表法将其分为干预组和对照组,每组41例。对照组给予常规护理方案,干预组在对照组基础上增加基于人工智能的随访方案。比较两组患者干预6个月内的主要心血管不良事件(major adverse cardiovascular event,MACE)发生率、30d再入院率、服药依从性和满意度评分。结果干预组患者6个月内的MACE发生率及30d再入院率均显著低于对照组(P<0.05)。干预6个月后,两组患者的Morisky量表评分和满意度评分均显著高于本组干预前(P<0.05),干预组患者的Morisky量表评分和满意度评分均显著高于对照组(P<0.05)。结论基于人工智能技术的随访方案可降低PCI术后患者的MACE发生率及30d再入院率。

CCTA-AI联合FFR-CT诊断冠状动脉狭窄病变的应用价值研究

目的评估计算机断层扫描血管成像(CCTA)与人工智能(AI)联合心肌灌注分数(FFR-CT)对冠状动脉狭窄病变的诊断价值。方法选择于2022年1月至2023年2月到南阳市中心医院接受诊治的80例疑似冠状动脉狭窄病变患者作为观察对象。所有患者均接受CCTA以及冠状动脉造影(CAG)检查,其检查的间隔时间应在14天内,然后通过AI软件自动对CCTA的图像进行重建和计算,同时计算FFR-CT的数值。计算人工智能辅助的心脏计算机断层扫描(CCTA-AI)联合FFR-CT诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果80例患者经CAG检查确诊,72例患者为冠状动脉狭窄病变,占比为90%;8例患者为非冠状动脉狭窄病变,占比为10%。CCTA-AI联合FFR-CT检查的敏感度、特异度、阳性预测值、阴性预测值、准确度以及AUC值均高于CCTA-AI、FFR-CT单独检查,差异有统计学意义(P<0.05)。结论采用CCTA-AI联合FFR-CT检查诊断冠状动脉狭窄病变具有较高的诊断效能,其敏感度及特异度均得到显著提高。

心脏磁共振自由呼吸运动校正人工智能电影序列在心力衰竭患者中的临床应用

目的通过评估自由呼吸运动校正人工智能(free-breathing with motion correction artificial intelligence,FB-MOCO AI)电影序列的图像质量、双心室容积和功能参数,探讨其在心力衰竭患者心脏磁共振(cardiac magnetic resonance,CMR)检查中应用的可行性。材料与方法前瞻性连续纳入2022年8月至2023年5月期间来我院进行CMR检查的心力衰竭患者29例。所有患者均行常规屏气电影和FB-MOCO AI电影序列的心脏短轴面扫描。由两名放射科医师对两种电影序列采集的图像进行整体图像质量评分(5分法)。测量两种序列的双心室容积和功能参数,包括舒张末期容积(end-diastolic volume,EDV)、收缩末期容积(end-systolic volume,ESV)、每搏输出量(stroke volume,SV)、射血分数(ejection fraction,EF)和左心室舒张末期质量(LV end-diastolic mass,LVEDM)。采用配对样本t检验或Wilcoxon符号秩检验来评估两种序列之间定量数据和定性评分数据的差异。并对两种序列间定量参数做相关性分析。通过Bland-Altman分析来评估从不同序列中获得的定量参数的一致性。结果FB-MOCO AI电影序列的总扫描时间[(14.3±1.9)s]比常规屏气电影[(79.2±11.4)s]明显缩短(P<0.001)。FB-MOCO AI电影[(4.4±0.5)分]的总体图像质量评分与常规屏气电影[(4.3±0.7)分]相当,差异无统计学意义(P=0.343)。两种电影序列间所有测量的双心室容积和功能参数以及LVEDM差异均无统计学意义(P值均>0.05),并且有强相关性(r值均≥0.94,P值均<0.001)。Bland-Altman分析显示,两种电影序列的所有心功能定量参数平均差异均接近于零,且变异范围很小,一致性高。结论与常规屏气电影序列相比,心衰患者中FB-MOCO AI电影序列扫描时间明显缩短并且提供了相当的图像质量、心室容积和功能指标,有潜力替代心衰患者的常规电影序列应用于临床。

急性心脏电极穿孔的处理策略分析

目的:分析和总结心律置入装置置入术后急性心脏电极穿孔的处理策略。方法:回顾性分析2007年1月至2019年1月,于北京大学人民医院因急性心脏电极穿孔成功拔除穿孔电极患者的临床资料。结果:共25例急性心脏电极穿孔患者成功拔除穿孔电极,其中合并心包积液4例(16.0%);伴有周围器官损伤1例(4.0%),表现为穿孔电极导线由右心室流出道部穿出,并穿入左肺,同时造成左侧液气胸。25例患者术前血流动力学均稳定,收缩压(129.7±11.2)mmHg(1mmHg=0.133kPa),舒张压(70.8±9.8)mmHg。经静脉拔除24例(96.0%),经开胸手术成功拔除穿孔电极1例(4.0%)。经静脉拔除患者中,直接拔除22例(88.0%),经锁定钢丝拔除2例(8.0%)。1例经静脉拔除患者术后发生肺栓塞,经抗凝治疗后好转。结论:对于血流动力学稳定且不伴周围器官损伤的急性心脏电极穿孔患者,经静脉拔除穿孔电极是安全有效的处理策略。

左束支区域起搏应用于心脏同步化治疗系统的对比研究

目的评估在需要行心脏再同步治疗的心力衰竭(HF)患者中行左束支区域起搏(LBBP)的临床应用价值。方法连续入选2018年1月至2023年1月于江苏省苏北人民医院心血管内科具备置入心脏同步化治疗(CRT)起搏器Ⅰ类和Ⅱ类适应证的HF患者128例,其中因冠状窦电极置入失败而置入左束支电极32例作为LBBP组,行传统双心室起搏(BVP)96例作为BVP组。观察置入时2组起搏参数等指标,于术后第1、3、6、12个月至江苏省苏北人民医院“心律失常与心脏起搏器”专病门诊随诊,之后每3~4个月随访1次,完善临床评估、12导联心电图、超声心动图、起搏器功能程控等检查,记录因HF再入院或死亡事件。结果与术前比较,2组患者末次随访QRS波时限、纽约心脏病协会(NYHA)心功能分级、左心室舒张末期内径降低,左心室射血分数(LVEF)升高(P<0.05);LBBP组末次随访QRS波时限、NYHA心功能分级低于BVP组,LVEF高于BVP组(P<0.05)。2组置入时和末次随访的起搏参数比较无显著差异(P>0.05)。LBBP组和BVP组再入院率比较无显著差异(18.75%vs 16.67%,P>0.05)。结论LBBP安全有效,可改善HF患者心功能,可能为传统CRT无效患者提供新的选择。