摘要
目的观察心室异常顺序激动患者行左束支起搏后电张调整性T波的特征。方法本回顾性队列研究选取2018年1月至2021年7月于南京医科大学第一附属医院心血管内科永久起搏器植入后(长时起搏组)、临时起搏术后(短时起搏组)或完全性左束支传导阻滞(左束支阻滞组)行左束支起搏的患者。记录并比较患者术前、术后1 d及术后1、3、6、12个月的心电图并分析QRS时限、QT间期、倒置T波(TWI)所在导联及其振幅。结果纳入89例患者,年龄69.0(57.0,74.0)岁,其中女41例(46.1%,41/89)。左束支起搏成功率为100%,80例(89.9%,80/89)患者术后出现TWI,长时起搏组、短时起搏组和左束支阻滞组的TWI发生率分别为96.4%(27/28)、86.4%(19/22)和87.2%(34/39,P=0.401)。术后TWI在主要导联的发生率为80.0%(64/80,Ⅱ导联)、68.8%(55/80,Ⅲ导联)、75.0%(60/80,aVF导联)、91.3%(73/80,V_(3)导联)、95.0%(76/80,V_(4)导联)、87.5%(70/80,V_(5)导联)、82.5%(66/80,V_(6)导联)。V_(4)、V_(5)导联TWI振幅最大,分别为-0.49(-0.31~-0.90)mV和-0.49(-0.27~-0.67)mV。术后1、3、6、12个月仍存在TWI的患者分别为53例(66.3%,53/80)、41例(51.3%,41/80)、35例(43.8%,35/80)、32例(40.0%,32/80)。TWI患者校正后的QT间期(QTc间期)在术后1 d大于术前,差异有统计学意义[(519±52)ms对(491±40)ms,P<0.001],术后1个月QTc间期(517±34 ms)与术后1 d相比差异无统计学意义(P=0.756),术后3个月QTc间期小于术后1 d,差异有统计学意义[(498±36)ms对(519±52)ms,P=0.005]。随访12.0(5.0~23.5)个月,随访期间导线参数稳定,有2例患者出现心力衰竭再住院事件。结论大多数心室异常顺序激动的患者行左束支起搏后会出现电张调整性T波现象,约50%患者的TWI在术后3个月内消失;TWI主要分布在V_(3)~V_(6)导联,V_(4)、V_(5)导联倒置T波振幅最大;QTc间期在术后延长,3个月左右恢复至术前。
Objective To elucidate the characteristics of electrotonic modulation of the T wave after correcting abnormal ventricular activation via left bundle branch pacing(LBBP).Methods In this historical cohort,the patients were enrolled from January 2018 to July 2021 in Department of Cardiology in The Frist Affiliated Hospital with Nanjing Medical University,who underwent permanent pacemaker implantation(long-time pacing group,LTP)or temporary pacemaker implantation(short-time pacing group,STP),or were complete left bundle branch block(LBBB,LBBB group)before receiving LBBP.We collected and analysed the electrocardiogram before and after implantation,and during follow up(1-month,3-month,6-month and 12-month).The QRS duration(QRSd),QT interval and T-wave inversion(TWI)were evaluated.Results A total of 89 patents were enrolled,median age 69.0(57.0,74.0),46.1%(41/89)female.LBBP success rate was 100%.TWI was observed in 80 cases(89.9%,80/89):96.4%(27/28)in the LTP,86.4%(19/22)in the STP and 87.2%(34/39)in the LBBB.TWI was observed mostly in the leadⅡ(80.0%,64/80),Ⅲ(68.8%,55/80),aVF(75.0%,60/80),V_(3)(91.3%,73/80),V_(4)(95.0%,76/80),V_(5)(87.5%,70/80)and V_(6)(82.5%,66/80).In the 80 cases,the leads with the maximum amplitude of TWI were V_(4)and V_(5)with the values of-0.49(-0.31--0.90)mV and-0.49(-0.27--0.67)mV,respectively.The number of patients with TWI during follow up(1-month,3-month,6-month and 12-month)were 53(66.3%,53/80),41(51.3%,41/80),35(43.8%,35/80),32(40.0%,32/80),respectively.Corrected QT interval(QTc)in the 80 patients with TWI after implantation was significantly longer than before implantation[(519±52)ms vs.(491±40)ms,P<0.001].There was no significant difference in QTc between 1-month follow up(517±34 ms)and after implantation,and the QTc in 3-month follow up(498±36 ms)was significantly shortened compared with after implantation(P=0.005).During a median follow-up of 12.0(5.0-23.5)months,capture threshold and impedance of LBBP lead were stable and 2 patients hospitalized for heart failure.Conclusion LB
作者
高越
王垚
钱智勇
薛思源
秦朝彤
徐顺
侯小锋
邹建刚
Gao Yue;Wang Yao;Qian Zhiyong;Xue Siyuan;Qin Chaotong;Xu Shun;Hou Xiaofeng;Zou Jiangang(Department of Cardiology,The First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China)
出处
《中华心律失常学杂志》
2022年第6期540-546,共7页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金(82070521)
江苏省新技术专项基金(JX233C202103)
江苏省人民医院临床能力提升项目(JSPH-MA-2020-3)。
关键词
心脏起搏
人工
左束支起搏
心脏记忆
心室异常顺序激动
T波倒置
QT间期
Cardiac pacing,artificial
Left bundle branch pacing
Cardiac memory
Abnormal activation sequence of ventricle
T wave inversion
QT interval
