超声心动图对左束支区域起搏电极定位及左心室收缩功能的评价

目的应用超声心动图对行左束支区域起搏（LBBP）患者的电极位置及左心室收缩功能进行评价。 方法选取2018年3月至2020年10月在中国科学院大学宁波华美医院行LBBP的患者64例。根据起搏电极位置将患者分为前室间隔组（17例）和后室间隔组（47例）；根据术前左心室收缩功能将患者分为左心室收缩功能正常组（44例）与左心室收缩功能减低组（20例）。所有患者均于术前3 d内及术后3个月行超声心动图检查，评估LBBP术起搏电极的定位，并对比分析LBBP术前、术后左心室收缩功能。 结果超声心动图显示前室间隔组、后室间隔组电极旋入深度分别为（10.6±1.6）mm、（10.3±1.6）mm，2组比较差异无统计学意义（P=0.72）；前室间隔组电极旋入点距主动脉右冠瓣距离为（23.9±5.5）mm，后室间隔组电极旋入点距三尖瓣隔瓣根部距离为（24.1±5.3）mm。左心室收缩功能正常组术前与术后3个月比较，左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）差异均无统计学意义（P均＞0.05）。左心室收缩功能减低组术后3个月的LVEDV、LVESV均较术前明显减小，LVEF较术前明显增大，差异均有统计学意义（P均＜0.05）。64例患者中，2例可见电极尖端穿透室间隔左心室面，进入左心室心腔，余62例无并发症发生。 结论LBBP可改善患者左心室收缩功能。超声心动图可显示LBBP电极入室间隔的深度及位置，为临床精准定位起搏提供有价值的信息，并在LBBP术前、术后左心室收缩功能的随访评估中发挥重要作用。

Echocardiographic evaluation of pacing electrode position and left ventricular ejection fraction in patients undergoing left bundle branch pacing

ObjectiveTo evaluate electrode position and left ventricular ejection fraction in patients undergoing left bundle branch pacing (LBBP) by echocardiography. MethodsSixty-four patients who underwent LBBP at Hwa Mei Hospital of University of Chinese Academy of Sciences from March 2018 to October 2020 were selected. According to the position of the pacing electrode, they were divided into an anterior ventricular septum group (17 cases) and a posterior ventricular septum group (47 cases). According to the preoperative left ventricular systolic function, the patients were divided into a normal left ventricular systolic function group (44 cases) and an abnormal left ventricular systolic function group (20 cases). All patients underwent echocardiography within 3 days before operation and 3 months after operation to evaluate the positioning of pacing electrodes , and to compare and analyze the left ventricular systolic function before and after LBBP operation. ResultsEchocardiography showed that the electrode screwing depths in the anterior ventricular septum group and the posterior ventricular septum group were (10.6±1.6) mm and (10.3±1.6) mm, respectively, and there was no significant difference between the two groups (P=0.72); the distance between the electrode screwing point and the right coronary valve of the aorta in the anterior ventricular septum group was (23.9±5.5) mm, while the distance between the electrode screw-in point and the root of the tricuspid septum in the posterior ventricular septum group was (24.1±5.3) mm. In patients with normal left ventricular systolic function, the left ventricular diastolic volume (LVEDV), left ventricular systolic volume (LVESV), and left ventricular ejection fraction (LVEF) before surgery were not statistically different from those at 3 months after surgery (P＞0.05 for all). In the abnormal left ventricular systolic function group, the LVEDV and LVESV at 3 months after operation were significantly lower than those before operation, and the LVEF was significantly higher than that before operation (P＜0.05 for all). Among the 64 patients, two had the electrode tip penetrating the left ventricular surface of the ventricular septum and entering the left ventricular cavity, and the other 62 had no complications. ConclusionLBBP can improve left ventricular systolic function in patients. Echocardiography can display the depth and position of the LBBP electrode into the ventricular septum, providing valuable information for accurate clinical positioning and pacing, and playing an important role in the follow-up assessment of left ventricular systolic function before and after LBBP surgery.