Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

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.

Biventricular pacing for treating heart failure in children: A case report and review of the literature

BACKGROUND Cardiac resynchronization therapy(CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.CASE SUMMARY This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block.Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.CONCLUSION Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.

Left bundle branch pacing in a ventricular pacing dependent patient with heart failure:A case report

BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.

Biventricular Pacing Therapy for Heart Failure

Heart failure is a disease with high morbidity and mortality. It is also the commonest cause of medical ward admission. The incidence of heart failure has been increasing world - wide in the past decade. Studies observed that about 25-50 % of patients with

Left bundle branch area pacing:A new era of cardiac resynchronization therapy?

The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.

Ischemic heart disease,factor predisposing to Barrett's adenocarcinoma: A case control study

AIM:To define the significance of ischemic heart disease(IHD)(stable angina to infarction) co-existance in Barrett esophagus(BE) patients and patients with esophageal adenocarcinoma(AdE).METHODS: All BE/AdE patients in Blackpool-Wyre-Fylde area and Trikala prefecture identified from medical records. Patient clinical details were obtained from hospital and General Practitioner records. Additional information was gathered from validated questionnaire.RESULTS: Forty(33%) AdE and 83(19%) BE patients had IHD(P = 0.002). Eighteen(15%) AdE and 34(8%) BE patients had suffered a myocardial infarction(P = 0.03). Three(3%) AdE and 7(2%) BE patients had severe heart failure(P = 0.82). Thirty-nine(47%) BE with IHD and 8(20%) AdE patients with IHD consumed aspirin daily(P = 0.004). Seventh-seven(93%) BE patients with IHD and 36(90%) AdE patients with IHD were on statins(P = 0.86). Logistic regression analysis: AdE was more frequent in the elderly,with long termreflux,long BE and concurrent IHD(odds ratio: 2.086,P = 0.001) not consuming statins. Eighteen(22%) BE patients with IHD [16(84%) with myocardial infarction] vs 33(10%) without IHD died from non-neoplastic causes within 24 mo from BE diagnosis(P = 0.005). CONCLUSION: IHD is more prevalent in AdE than BE patients. Increased prevalence of AdE is related with the presence of myocardial infarction but not severe heart failure,possibly because patients with BE and se-vere IHD have low life expectancy.

The importance of avoiding unnecessary right ventricular pacing in clinical practice

Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with longterm pacing of the apex of the right ventricle(RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function(LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing(cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.

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.

Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis:A systematic review

BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.

The Prevalence and Short-Term Outcomes of Ventricular Dyssynchrony after Right Ventricular Pacing

Objective: Long-term right ventricular pacing has been associated with an increased risk of heart failure and cardiomyopathy. The pathophysiology of cardiomyopathy associated with right ventricular pacing remains unclear. We aim to evaluate the burden and short-term outcomes of ventricular dyssynchrony after immediate permanent pacemaker implantation. Materials and Methods: This prospective cohort study examined consecutive patients who had permanent pacemaker implantation at Vajira Hospital in 2019. Left ventricular systolic function, specifically left ventricular ejection fraction (LVEF) and echocardiographic ventricular dyssynchrony parameters were assessed. The endpoints included the prevalence of ventricular dyssynchrony, new-onset cardiomyopathy, heart failure, and death. The correlation between QRS complex duration, the burden of ventricular pacing, and echocardiographic ventricular dyssynchrony was measured. Results: Thirty-six consecutive patients underwent pacemaker implantation. The prevalence of mechanical ventricular dyssynchrony was 22.2% using the interventricular conduction delay method, 41.7% using LV pre-ejection period method, and 11.1% using the septal posterior wall motion abnormality method. Electrical ventricular dyssynchrony was 86.1% and new-onset cardiomyopathy was 17.1% after 3 months of permanent pacemaker implantation. The right ventricular pacing of more than 20% was significantly associated with cardiomyopathy (p < 0.022) and heart failure (log-rank, p = 0.049) within 3 months. But heart failure was not associated with mechanical ventricular dyssynchrony parameters (log-rank, p = 0.610;hazard ratio [HR], 1.53;95% confidence interval [CI], 0.29 - 7.96;p = 0.613 for IVMD and log-rank, p = 0.398;HR, 0.04;95% CI, 0.01 - 3316.7 for SPWMD). Conclusion: Mechanical and electrical ventricular dyssynchrony are common findings in right ventricular pacing. High-burden right ventricular pacing after 3 months of permanent pacemaker implantation is often associated with cardiomyopathy and heart failure, but mechanical and electrical ventricular dyssynchrony does not predict a short-term decline in left ventricular systolic function and heart failure.

左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响

目的探讨左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响。方法回顾性选取2022年2月至2023年3月期间于郴州市第一人民医院心血管内科接受永久性心脏起搏器植入术治疗的80例老年患者的临床资料,根据心脏起搏电极植入部位分为两组,即对照组、观察组各40例。对照组患者于右心室间隔处植入心脏起搏器,观察组患者于左束支区域植入心脏起搏器。分别于患者心脏起搏器植入术后1个月、术后6个月、术后12个月观察各指标变化,包括左心室收缩同步性参数[左心室收缩期纵向应变达峰时间标准差(time to peak longitudinal strain standard deviation,Tls-SD)、最大差值(time to peak longitudinal strain maximum difference,Tls-dif),左心室收缩期径向应变达峰时间标准差(time to peak radial strain standard deviation,Trs-SD)、最大差值(time to peak radial strain maximum difference,Trs-dif),左心室收缩期环向应变达峰时间标准差(time to peak circumferential strain standard deviation,Tcs-SD)、最大差值(time to peak circumferential strain maximum difference,Tcs-dif)]以及心功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)、心排血量(cardiac output,CO)、心脏指数(cardiac index,CI)]、心腔大小[右心房内径(right atrial inner diameter,RAD)、左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)]、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度等。于术后12个月测定起搏参数(感知、阈值、阻抗、心室起搏比例),并统计心脏起搏器植入术后12个月内心力衰竭再入院、死亡等不良事件发生情况。结果术后各时间点观察组心功能指标LVEF、CO、CI略高于对照组,但两组比较差异无统计学意义(P>0.05)。术后各时间点观察组心腔大小指标RAD、LAD、LVEDD、LVESD低于对照组,尤其是术后12个月[RAD:(36.63±2.22)mm vs.(40.13±1.61)mm,LAD:(31.09±1.14)mm vs.(38.32±1.08)mm,LVEDD:(49.76±3.22)mm vs.(54.63±3.14)mm,LVESD:(40.64±2.11)mm vs.(48.11±3.24)mm,P<0.05]。术后各时间点观察组左心室收缩同步性指标LSDI、Tls-SD、Tls-dif、Trs-SD、Trs-dif、Tcs-SD、Tcs-dif均低于对照组,尤其是术后12个月[LSDI:4.86%±0.83%vs.9.49%±0.48%,Tls-SD:(14.42±1.78)ms vs.(25.00±1.43)ms,Tls-dif:(50.92±4.53)ms vs.(90.17±8.41)ms,Trs-SD:(50.37±4.33)ms vs.(69.44±6.52)ms,Trs-dif:(141.03±15.64)ms vs.(179.04±18.42)ms,Tcs-SD:(37.85±3.41)ms vs.(48.10±4.62)ms,Tcs-dif:(130.09±14.53)ms vs.(158.09±18.57)ms,P<0.05]。术后各时间点观察组NT-proBNP浓度略低于对照组,但两组比较差异无统计学意义(P>0.05)。两组起搏程控参数起搏感知、阻抗比较,差异无统计学意义(P<0.05);观察组起搏阈值低于对照组[(0.66±0.10)V vs.(0.75±0.12)V,P<0.05];两组起搏程控参数起搏感知、阻抗、阈值均处于正常范围。观察组心室起搏比例低于对照组(43.23%±4.53%vs.73.43%±6.56%,P<0.05)。术后12个月观察组心力衰竭再入院发生率明显低于对照组,差异有统计学意义(5.00%vs.22.50%,P<0.05)。结论左束支区域起搏技术在改善永久性心脏起搏器植入患者左心室收缩同步性、心功能方面优于右心室间隔起搏技术,术后12个月不良事件发生率较低,更有利于保护心功能,起搏参数稳定,属于一种有效且安全的起搏技术。

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。

希浦系统起搏对心功能影响的研究进展

心脏起搏是心脏起搏、传导功能障碍及严重心力衰竭的有效治疗手段,但传统右心室起搏可增加心力衰竭、心房颤动发生率,双心室起搏具有相对较高的无应答率。近年来多项研究显示,希浦系统起搏作为生理性起搏新技术,起搏参数稳定,心脏同步性好。本文就目前希浦系统起搏对心功能影响的研究现状及进展进行综述,为促进希浦系统起搏技术发展提供理论依据。

LBBP—慢性心力衰竭再同步化治疗的优选?

慢性心力衰竭(chronic heart failure,CHF)作为常见的心血管疾病,多存在心脏电-机械失同步。心脏再同步治疗(cardiac resynchronization therapy,CRT)是一种有效治疗伴有心室不同步的难治性CHF的方式。传统的双心室起搏(biventricular pacing,BVP)CRT能够纠正CHF患者的电-机械失同步,逆转心脏重构,改善临床症状的同时明显降低患者再住院率及死亡率。但是其并非真正意义上的生理性同步起搏,且有将近30%的患者不能从中获益。近来以希氏束起搏(His bundle pacing,HBP)和左束支起搏(left bundle branch pacing,LBBP)为代表的希-浦系统起搏作为生理性起搏在CHF再同步化治疗中得到了肯定。尤其是LBBP,在达到更窄的QRS波的同时、具有更低的阈值和更稳定的输出。本文概述LBBP在CHF防治中的应用现状及前景。

巨大心脏TAVR中应用左心室导丝起搏技术1例

1临床资料患者男,74岁。因“反复胸闷气促45年,加重3 d”于2023年6月8日入广东省中医院。患者45年前出现胸闷、气促,伴心悸,诊断为风湿性心脏病行二尖瓣瓣膜置换术,维持华法林等药物治疗。2015年6月诊断为心房颤动伴长R-R间期行单腔永久起搏器植入术,2021年3月起搏器程控提示电量耗竭,植入Micra无导线起搏器,期间冠脉造影未见冠脉病变。

左束支区域起搏对慢性收缩性心力衰竭患者左心室收缩同步性、预后的影响

目的:探究左束支区域起搏(LBBAP)对慢性收缩性心力衰竭患者左心室收缩同步性、预后的影响。方法:根据不同起搏方式将德驭医疗马鞍山总医院2020年6月~2021年12月收治的110例慢性收缩性心力衰竭患者分为LBBAP组(60例)与右心室起搏(RVP)组(50例)。对比两组手术前、3个月后起搏参数、心功能、左室收缩同步性等相关指标及6个月后的预后情况。结果:术后3个月,与RVP组比较,LBBAP组起搏阻抗[(560.34±61.32)Ω比(507.20±44.29)Ω]、QRS时限[(132.57±22.91)ms比(123.61±20.55)ms]以及左心室收缩同步性参数中峰值应变离散度(PSD)[(58.24±10.57)ms比(45.30±6.20)ms]、纵向收缩应变达峰时间差(Tls-Dif)[(238.57±50.13)ms比(152.42±40.15)ms]、横向收缩同步性标准差(Trs-SD)[(122.35±9.14)ms比(78.18±5.46)ms]、前间隔-左心室后壁收缩期径向应变达峰时间差(Tas-post)[(138.19±20.36)ms比(69.14±20.45)ms]均显著减少,左室射血分数(LVEF)[(46.62±5.80)%比(50.54±5.68)%]显著提高(P<0.05或<0.01)。LBBAP组术后6个月心脏再同步化治疗(CRT)有反应比例显著高于RVP组(88.33%比72.00%,P=0.030),两组心衰再入院率、全因死亡率对比均无明显差异(P均>0.05)。结论:LBBAP能有效改善慢性收缩性心力衰竭患者心功能,保证左心室收缩的同步性,CRT有反应率高,预后较好。

左束支区域起搏应用于合并左束支阻滞心力衰竭患者的研究进展

生理性起搏如希氏束起搏和左束支区域起搏能明显改善心脏电机械收缩同步性,而左束支区域起搏相较于希氏束起搏植入成功率高,起搏阈值低而稳定,且并发症发生率较低。左束支区域起搏用于合并左束支阻滞的慢性心力衰竭患者的可行性、安全性和有效性已得到初步证实,逐渐成为研究的热点。现就左束支区域起搏在合并左束支阻滞的心力衰竭患者中的相关研究及进展做一综述。