摘要
目的通过单中心回顾性分析,探讨希氏-浦肯野系统起搏(HPCSP)在有起搏适应证且合并巨大右心房患者中的临床应用。方法连续纳入2017年1月至2019年12月在浙江大学医学院附属邵逸夫医院行永久起搏器植入术的巨大右心房患者155例,分为3组:希氏束起搏(HBP)组53例,男35例,年龄(69.5±11.7)岁;左束支起搏(LBBP)组72例,男44例,年龄(71.3±8.6)岁;右心室起搏(RVP)组30例,男20例,年龄(69.5±10.3)岁。评估和比较术中及随访期间导线阈值、感知、阻抗等参数和左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)、右心室收缩压(RVSP)等超声心动图指标。结果3组患者术前基线资料差异无统计学意义。①成功行HBP 45例(84.9%,45/53),成功行LBBP 68例(94.4%,68/72);RVP组所有患者均成功植入。②与RVP组比较,HBP组术中阈值及R波感知差异有统计学意义,而阻抗差异无统计学意义。③3组患者随访期间阈值、感知、阻抗较术中均差异无统计学意义。HBP组和LBBP组术前及随访期间LVEF和LVEDD的差异均无统计学意义,RVSP均较基线下降[HBP组:(44.0±19.9)mmHg(1 mmHg=0.133 kPa)对(50.1±25.4)mmHg,P=0.04;LBBP组:(41.8±15.7)mmHg对(51.7±19.8)mmHg,P=0.03]。RVP组在随访期间LVEF较基线下降(45.1%±18.2%对50.8%±19.9%,P=0.04),LVEDD及RVSP差异无统计学意义。结论HPCSP在巨大右心房患者中的应用是安全有效的。对于有起搏适应证的巨大右心房患者,HPCSP可能是较优选择,可通过鞘管塑形或使用"鞘中鞘"等技术提高植入成功率。
Objective To explore the clinical application of His-Purkinje conduction system pacing(HPCSP)in patients with giant right atrium.Methods We consecutively recruited 155 patients with giant right atrium scheduled to have pacemaker implantation from January 2017 to December 2019 in Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,and explored the parameter changes and clinical outcomes.His bundle pacing(HBP)was performed in 53 patients[including male 35,with an average age of(69.5±11.7)years],and left bundle branch pacing(LBBP)was performed in 72 patients[including male 44,with an average age of(71.3±8.6)years],and right ventricular pacing(RVP)was performed in 30 patients[including male 20,with an average age of(69.5±10.3)years].The parameters such as lead threshold,perception,impedance,and echocardiographic indexes such as left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and right ventricular systolic pressure(RVSP)were evaluated and compared during operation and follow-up.Results The baseline demography was not significantly different among three groups.①The pacing success rates were 84.9%(45/53),94.4%(68/72)and 100%in three groups respectively.②Compared to RVP pacing,HBP pacing had a significant difference in threshold(P=0.04)and amplitude(P=0.01).③All the parameters were remained stable during follow-up period.Both LBBP and HBP patients had similar LVEF and LVEDD without significant change compared with baseline.Compared to baseline,RVSP in HBP group and LBBP group was significantly lower than baseline[HBP group:(44.0±19.9)mmHg vs.(50.1±25.4)mmHg,P=0.04;LBBP group:(41.8±15.7)mmHg vs.(51.7±19.8)mmHg,P=0.03].There was no significant difference in LVEDD and RVSP in RVP group,while LVEF was significantly decreased[(45.1%±18.2%)vs.(50.8%±19.9%),P=0.04].Conclusion HPCSP is feasible and safe for patients with giant right atrium.Unique techniques such as sheath remolding or supported by the left ventricular lead delivery system could increase the success rate of HPCSP in patients with giant right atrium.
作者
潘轶文
张杰芳
盛夏
王敏
徐添添
孙雅逊
杨莹
傅国胜
Pan Yiwen;Zhang Jiefang;Sheng Xia;Wang Min;Xu Tiantian;Sun Yaxun;Yang Ying;Fu Guosheng(Department of Cardiology,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,China)
出处
《中华心律失常学杂志》
2021年第5期397-402,共6页
Chinese Journal of Cardiac Arrhythmias
基金
浙江省卫生厅青年人才项目(2019RC188)。
关键词
心脏起搏
人工
希氏-浦肯野系统起搏
希氏束起搏
左束支起搏
右心室起搏
巨大右心房
Cardiac pacing,artificial
His-Purkinje conduction system pacing
His-bundle pacing
Left bundle branch pacing
Right ventricular pacing
Giant right atrium
