摘要
目的比较左束支起搏(LBBP)与右室间隔部起搏(RVSP)对电-机械同步性、起搏参数、心脏结构及功能的影响。方法收集2020年6月至2021年12月在河南省胸科医院行永久双腔起搏器的患者,根据起搏部位分为LBBP组和RVSP组。比较两组起搏前后QRS波时限变化,起搏术前/术中、术后1及6个月、1年起搏参数(阈值、阻抗)及心脏结构及功能[左室舒张末期内径(LVEDD)、左房内径(LAD)、左室射血分数(LVEF)]变化和并发症情况。结果共入选136例,其中LBBP组74例,RVSP组62例。LBBP组QRS波时限术前、术后无差异[(112.7±20.8)msvs(114.9±10.9)ms,P>0.05],RVSP组术后QRS波明显延长[(142.0±14.9)msvs(111.1±22.3)ms,P<0.01],术后RVSP组较LBBP组时限明显延长(P<0.01)。两组的阈值、阻抗在术后1个月较术中明显下降(P<0.01),后达到稳定,且两组相比无差异(P>0.05)。LBBP组术后6个月及1年LVEDD、LAD较术前降低,LVEF较术前升高。RVSP组术前、术后LVEDD、LAD无变化,术后1年LVEF减低。术后6个月及1年LBBP组LVEDD较RVSP组小,LVEF较RVSP组高,术后1年LBBP组LAD低于RVSP组(P均<0.05)。两组患者手术后均未出现并发症。结论与RVSP相比,LBBP可保持良好的电-机械同步性,起搏参数良好,且更利于改善患者的心脏结构及功能。
Objective To compare the effects of left bundle branch pacing(LBBP)and right ventricular septal pacing(RVSP)on electro-mechanical synchronization,pacing parameters,cardiac structure and function.Methods Patients who received permanent pacemaker in Henan Chest Hospital from June 2020 to December 2021 were collected.They were divided into LBBP group and RVSP group.The changes of QRS duration before and after pacing were compared between the two groups.The pacing parameters(threshold,impedance)and cardiac structure and function left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD),left ventricular ejection fraction(LVEF)and the complications were compared between the two groups before/during surgery and 1 month,6months,1 year after surgery.Results One hundred and thirty-six patients were included.The duration of postoperative QRS in LBBP group had no difference compared with that before surgery[(112.7±20.8)ms vs(114.9±10.9)ms,P>0.05],while the duration of postoperative QRS in RVSP group was significantly prolonged[(142.0±14.9)ms vs(111.1±22.3)ms,P<0.01].The postoperative QRS duration in LBBP group was significantly longer than that in RVSP group(P<0.01).The threshold value and impedance of the two groups decreased significantly 1 month after surgery compared with that of the surgery(P<0.01),and then reached stability.There were no differences between the two groups(P>0.05).Compared with the preoperative results,LVEDD、LAD in the LBBP group decreased significantly and LVEF increased significantlyat 6 months and 1 year after surgery.LVEDD and LAD were no differences in RVSP group before and after operation,and LVEF decreased at 1 year after surgery.LVEDD in LBBP group was lower than that in RVSP group at 6 months and 1 year after surgery.LVEF was higher than that in RVSP group at 6 months and 1 year after surgery.LAD was significantly lower than that in RVSP group at 1 year after surgery(P<0.05).There were no postoperative complications in both two groups.Conclusion Compared with RVSP,LBBP can
作者
沈静
范玉欢
吴志红
HEN Jing;FA Yu-huan;WU Zhi-hong(Henan Provincial Chest Hospital,Zhengzhou University,Zhengzhou 45ooo0,Henan,China)
出处
《中国心脏起搏与心电生理杂志》
2023年第5期406-409,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
基金
河南省医学技术攻关计划联合共建项目(LHGJ20200210)。
关键词
心血管病学
左束支起搏
右室间隔部起搏
同步性
起搏参数
心脏结构
心脏功能
Cardiology
Left bundle branch pacing
Right ventricular septal pacing
Synchronization
Pacing pa-rameters
Cardiac structure
Cardiac function
