摘要
目的探讨左束支起搏(LBBP)优化心脏再同步化治疗(CRT)的可行性,并评估对心功能的改善效果。方法纳入2021年1月至2022年3月在铜陵市人民医院心血管内科行LBBP联合左心室心外膜起搏(LVEP)以优化CRT(联合起搏)的心力衰竭患者11例,评估成功率及安全性。比较术前、术中不同起搏方式及术后QRS宽度,随访纽约心脏病协会(NYHA)心功能分级、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)等指标,评估LBBP优化CRT对心功能改善的效果。结果11例患者平均年龄(68.7±9.5)岁,行联合起搏成功7例。术前、LVEP、LBBP及联合起搏后心电图平均QRS宽度分别为163.6 ms、151.4 ms、125.7 ms、129.3 ms,其中联合起搏QRS宽度分别低于术前(P<0.001)及LVEP(P=0.001),差异均有统计学意义,但与LBBP比较差异无统计学意义(P>0.05);LBBP后QRS宽度低于LVEP,差异有统计学意义(P<0.001)。随访3个月后,联合起搏LVEF由术前31.7%上升至38.1%,差异有统计学意义(P=0.018),NYHA心功能分级、LVEDd及心胸比例均有所下降,但差异均无统计学意义(均P>0.05)。结论LBBP联合LVEP以优化CRT可行性高,能够改善心脏电同步性及心功能,可能成为后期心力衰竭器械治疗的重要研究方向。
Objective To determine if cardiac resynchronization therapy could be optimized by left bundle branch pacing(LBBP)and to evaluate the improvement effect on cardiac function.Methods Patients with heart failure who were hospitalized in the department of Cardiology from January 2021 to March 2022 and met the standard of traditional CRT implantation were selected to receive LBBP optimized CRT,namely LBBP combined with left ventricular epicardial pacing(LVEP).The QRS width of baseline,during and after surgery were compared,and the changes of New York cardiac function grading,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd)and other indicators were followed up to evaluate the eff ect of LBBP-optimized CRT on the improvement of cardiac function.Results A total of 11 patients planned to perform LBBP optimized CRT,and 7 patients were successful.In the successful patients,the QRS duration were 163.6 ms,151.4 ms,125.7 ms and 129.3 ms during the baseline、LVEP、LBBP and combined pacing.The QRS duration of combined pacing was shorter than that of baseline(P<0.001)and LVEP(P=0.001),and there was no statistic diff erence compared with LBBP(P>0.05).The QRS duration after LBBP was shorter than LVEP(P<0.001).During a mean follow-up of 3 months,LVEF improved from 31.7%to 38.1%(P=0.018),Cardiac function grade,LVEDd and cardiothoracic ratio all decreased,but there were no statistic diff erence(all P>0.05).Conclusions LBBP optimizated CRT is feasible,which can improve cardiac electrical synchronization and cardiac function and may be an important research direction for the treatment of heart failure in the future.
作者
张斌
乔建忠
汪杰
潘令新
王园
熊恩来
ZHANG Bin;QIAO Jian-zhong;WANG Jie;PAN Ling-xin;WANG Yuan;XIONG En-lai(Department of Cardiology,Tongling People’s Hospital,Tongling 244000,China)
出处
《中国介入心脏病学杂志》
CSCD
2023年第8期585-590,共6页
Chinese Journal of Interventional Cardiology
基金
铜陵市卫科研(2021)7号。
关键词
心力衰竭
心脏再同步化治疗
左束支起搏
左心室心外膜起搏
优化
Heart failure
Cardiac resynchronization therapy
Left bundle branch pacing
Left ventricular epicardial pacing
Optimize
