左束支起搏的心脏电学和机械同步性及中远期导线稳定性研究

目的:本研究观察左束支起搏(LBBP)的心脏电学和机械同步性以及中远期导线参数稳定性,旨在评估其生理性以及可靠性。方法:连续入选2018年1月25日至2019年1月25日就诊我院符合起搏适应证并成功施行LBBP的患者96例,详细记录患者的临床资料以及术中导线单、双极参数。于术后3天、1个月、3个月、6个月以及12个月随访,测试导线单、双极参数并记录随访期内并发症。筛选其中诊断病窦综合征(SSS)伴基线QRS时限正常的患者36例进行心室同步性分析。起搏器程控分为两种状态:(1)AAI模式:起搏器工作方式为心房起搏-心室感知,保证激动沿自身传导束下传心室;(2)DDD模式且房室间期

Evaluation of Cardiac Electrical and Mechanical Synchrony of Left Bundle Branch Pacing and Middle-and Long-term Leads Parameters Stability

Objectives:To evaluate the physiology and validity of left bundle branch pacing(LBBP)by observations of the cardiac synchrony and the middle-and long-term stability of leads parameters.Methods:Ninety-six patients received LBBP in the Xiamen Cardiovascular Hospital from Jan 25th 2018 to Jan 25th 2019 were enrolled in this study.We followed up these patients at 3 days,1 month,3 months,6 months and 1 year after implantation,related parameters were measured and complications were recorded.We observed the cardiac synchrony in 36 patients diagnosed as sick sinus syndrome(SSS)with normal QRS duration(QRSd)using ECG and tissue Doppler imaging(TDI)technique.QRSd,intraventricular and interventricular synchrony were compared between LBBP and self-conduction status.The standard deviation of the left ventricular 12 segments(Tsd-12-LV)and the difference between left ventricular lateral wall and right ventricular free wall(Ts-LV-RV)were evaluated to assess intraventricular and interventricular synchrony.Results:There were 51 cases of AVB(53.1%)and 39 cases of SSS(40.6%).Forty-five patients(46.9%)were male and the average age was(67.2+7.4)years old.The parameters of both unipolar and bipolar leads were satisfactory during the implantation and remained stable in middle-and long-term follow-up.Eleven patients(11.5%)experienced transient RBBB during implantation,there were no myocardia perforation,aorta and coronary artery lesions or lead dislocation during follow-up.Paced QRSd was wider than intrinsic QRSd([104.4±10.0]ms vs[91.7±15.1]ms,P=0.02),while Tsd-12-LV and Ts-LV-RV was similar between the LBBP group and the self-conduction status(Tsd-12-LV:[27.7±14.8]ms vs[26.6±15.4]ms,P=0.60,Ts-LV-RV:[8.1±56.7]ms vs[17.4±52.1]ms,P=0.44).Conclusions:LBBP could achieve favorable cardiac electrical and mechanical synchrony together with good stability and safety.LBBP serves as a kind of physiological pacing which is worth popularizing.