左束支起搏对合并右束支传导阻滞患者的心电学影响

目的探讨左束支起搏对症状性心动过缓合并右束支传导阻滞患者的心电学影响。 方法连续纳入2019年1月1日至2021年12月31日因症状性心动过缓合并完全性右束支传导阻滞并在厦门大学附属心血管病医院心内科拟行左束支起搏的患者，记录标准12导联体表心电图。比较左束支起搏术前与术后V₁导联QRS波形态、QRS时限、右心室延迟激动时间（dRVAT）、左心室达峰时间（LVAT）及心室间延迟时间（IVD）的差异。 结果共入选53例患者，年龄（72.15±9.39）岁，男34例。其中46例（86.79%，46/53）成功完成左束支起搏。术前V₁导联以rsR’型为主38例（38/46，83%），术后QRS形态以Qr型为主29例（29/46，63%）。左束支起搏可以显著缩短QRS时限［（149.09±12.81）ms对（112.46±9.64）ms，P<0.001）］，其中35例（76.08%，35/46）患者的QRS时限完全纠正，10例（21.73%，10/46）部分纠正，1例（2.17%，1/46）未纠正；IVD显著缩短［（58.28±12.54）ms对（34.34±8.87）ms，P<0.001］；但在dRVAT方面左束支起搏术前与术后差异无统计学意义［（100.47±12.40）ms对（100.86±10.57）ms，P=0.955］。与术前相比，左束支起搏延长LVAT［（42.46±6.95）ms对（66.53±10.83）ms，P<0.001］。 结论左束支起搏可显著缩短完全性右束支传导阻滞患者的QRS时限，并改善其心室间电学同步性，产生以Qr型为主的起搏后QRS波形态。

Effect of left bundle branch pacing on electrocardiogram in patients with right bundle branch block

ObjectiveTo investigate the electrocardiographic effects of left bundle branch pacing (LBBP) in symptomatic bradycardia patients with intrinsic complete right bundle branch block (RBBB). MethodsAll of the patients with symptomatic bradycardia and intrinsic complete RBBB were consecutively enrolled from January 2019 to December 2021, attempting to do LBBP in the Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University. In the standard 12-lead electro cardiogram, QRS morphology in lead V₁, QRS duration, delayed right ventricular activation time (dRVAT), left ventricular activation time (LVAT) and inter-ventricular conduction delay (IVD) were documented and compared between before and after LBBP respectively. ResultsA total of 53 patients were included, (72.15±9.39)years old, and 34 of them were male. Forty-six of them underwent LBBP successfully. The QRS morphology was primarily rsR' pattern (83%) before LBBP, whereas the QRS morphology of LBBP was mainly Qr pattern (29/46,63%). When compared to pre-procedure, LBBP significantly reduced the QRS duration (149.09±12.81) ms vs. (112.46±9.64) ms, P<0.001], fully corrected the QRS duration in 76.08%,(35/463) of cases, partially corrected in 21.73%(10/46), and uncorrected in 2.17%(1/46), and improved IVD (58.28±12.54) ms vs. (34.34±8.87) ms, P<0.001], but increased LVAT (42.46±6.95) ms vs. (66.53±10.83) ms, P<0.001]. There was no significant difference in dRVAT (100.47±12.40) ms vs. (100.86±10.57) ms, P=0.955]. ConclusionLBBP can reduce the QRS duration of intrinsic complete RBBB, improve the interventricular electrical synchronization, and present a Qr-dominated pattern in lead V₁.