| 希氏束起搏对房颤并发心衰患者的疗效观察 |
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| 引用本文： | 闫群,李洁,郭兰燕.希氏束起搏对房颤并发心衰患者的疗效观察[J].心脏杂志,2021,33(4):429-432. |
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| 作者姓名： | 闫群 李洁 郭兰燕 |
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| 作者单位： | 空军军医大学西京医院心内科，陕西 西安 710032 |
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| 基金项目： | 西京医院学科助推项目资助（XJZT18ML71） |
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| 摘 要： | 目的 探讨希氏束起搏（HBP）对心房颤动（AF）伴射血分数下降的心力衰竭(HFrEF)患者心功能的影响，包括双心室+希氏束起搏（BiV/HBP）与右室+希氏束起搏（RVP/HBP）两种治疗方式。 方法 回顾分析26例AF伴HFrEF行HBP的患者，根据手术方式分为两组:A组（BiV/HBP）20例，B组（RVP/HBP）6例，随访记录两组患者治疗前后心腔大小、左心功能、心电图和心肌损伤标志物、生化离子水平的改变及电极导线的参数等。 结果 AF并发HFrEF的患者HBP治疗可以缩小心腔，改善心功能。BiV/HBP与RVP/HBP组相比，心功能LVEF更差，左心室直径及容积更大，P<0.01，但2组治疗后心腔大小及心功能无显著差异；术后心功能LVEF与术前LVEF呈正相关，与术前ESV、EDV、左室大小和QRS宽度呈负相关。 结论 希氏束起搏治疗HF并发HFrEF是可行的，对于心脏明显扩大、心功能更差（LVEF<35%）、QRS较宽的患者行BiV/HBP比行RVP/HBP治疗效果更加显著。
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| 关 键 词： | 心房颤动 心力衰竭 希氏束起搏 |
| 收稿时间： | 2021-04-08 |
Observation of therapeutic effect of His bundle pacing on patients with atrial fibrillation complicated with heart failure |
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| Affiliation: | Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi, China |
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| Abstract: | AIM To discuss the effects of His bundle pacing (HBP), including biventricular + His bundle pacing (BiV/HBP) and right ventricle + His bundle pacing (RVP/HBP) on the cardiac functions in atrial fibrillation (AF) patients with heart failure with decreased ejection fraction (HFrEF). METHODS Retrospective analysis was performed on 26 AF patients combined with HFrEF who underwent HBP and the patients were divided into two groups according to their surgical methods: group A (20 cases, BIV/HBP) and group B (6 cases, RVP/HBP). The changes of cardiac chamber size, cardiac functions and ECG, myocardial injury markers, biochemical ion levels and parameters of electrode conductors in the two groups before and after treatment were recorded. RESULTS HBP therapy shrinked the heart cavity and improved the cardiac functions in AF patients combined with HFrEF. Compared with the RVP/HBP group, patients in the BIV/HBP group had larger left ventricle and worse cardiac functions preoperatively, but there were no significant differences in cardiac chamber size and cardiac function between the two groups after treatment. Postoperative cardiac function LVEF was positively correlated with preoperative LVEF and was negatively correlated with preoperative ESV, EDV, left ventricular size and QRS width. CONCLUSION It is feasible to use His pacing in treatment of AF patients combined with HFrEF. For patients with significantly enlarged heart and worse cardiac functions (LVEF<35 %), BIV/HBP can bring more significant clinical benefits than RVP/HBP in patients with wider QRS. |
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