经导管主动脉瓣植入术后左束支起搏的临床应用初探

目的:探讨左束支区域起搏（LBBP）运用于经导管主动脉瓣植入术（TAVI）后患者的可行性和安全性。方法:本研究为回顾性研究。连续入选2018年1月至2020年12月在中国医学院科学院阜外医院接受TAVI治疗、术后置入永久起搏器的患者35例。根据心室电极放置位置，分为LBBP组（12例）和右心室心尖部起搏（RVAP）组（...

Initial clinical experience of left bundle branch pacing after transcatheter aortic valve implantation

Objective To investigate the efficacy and safety of left bundle branch pacing(LBBP)in patients after transcatheter aortic valve implantation(TAVI).Methods This is a retrospective study.A total of 35 patients underwent TAVI and received pacemaker implantation from January 2018 to December 2020 in Beijing Fuwai Hospital were enrolled.Patients were divided into LBBP group(n=12)and right ventricular apex pacing(RVAP)group(n=23)according to the pacing position.The success rate of operation in LBBP group was calculated,and the occurrence of complications were observed,and the parameters of pacemaker were measured on the 3rd day and 1,3 and 6 months after operation.The N-terminal pro-B-type natriuretic peptide(NT-proBNP),echocardiographic and ECG indexes were compared between the two groups on the 3rd day and 1,3,and 6 months after pacemaker implantation.Result A total of 35 patients were included,The age was(76.4±7.7)years,including 19 males(54.3%).The procedure time((86.58±17.10)min vs.(68.74±9.18)min,P<0.001)and fluoroscopy duration((20.08±4.44)min vs.(17.00±2.26)min,P<0.001)were significantly longer in LBBP group compared with RVAP group.The operation success rate of LBBP group was 11/12.There was no serious operation related complications such as pneumothorax,hemothorax,electrode dislocation,infection,and lower limb bleeding.The patients were followed up for 7.43(5.21,9.84)months.The programmed parameters of pacemaker were in the ideal range and stable during follow-up.At 3 and 6 months after operation,the left ventricular ejection fraction in LBBP group was higher than that in RVAP Group(at 3 months:(60.75±2.89)%vs.(57.35±3.33)%,P=0.004;at 6 months:(63.17±3.33)%vs.(56.17±3.97)%,P<0.001),NT-proBNP values was lower in LBBP group than that in RVAP Group(at 3 months:822(607,1150)ng/L vs.1052(902,1536)ng/L,P=0.006;at 6 months:440(330,679)ng/L vs.783(588,1023)ng/L,P=0.001).At 1,3 and 6 months after operation,the QRS duration was shorter in LBBP group than that in RVAP group(1 month:99(97,107)ms vs.126(124,130)ms,P<0.001;3 months:98(96,105)ms vs.129(128,133)ms,P<0.001;6 months:96(94,104)ms vs.130(128,132)ms,P<0.001).Conclusions For patients with permanent pacemaker indications after TAVI,LBBP is feasible,safe and reliable.It could improve the cardiac function in the short term,the long-term effect of LBBP needs to be further observed.