三维标测系统指导下永久希氏束起搏的临床研究

目的分析与评价三维标测系统指导希氏束起搏植入的可行性与效果。方法入选2016年1月至2018年5月于河南省人民医院/华中阜外医院拟在三维标测系统下行永久希氏束起搏的患者30例,平均年龄59.2岁,其中男性17例。对希氏束起搏手术相关研究指标进行分析,包括希氏束起搏手术时间,术中X线曝光时间,导线参数,术前、术后QRS波宽度等。结果根据希氏束导线的植入部位,将患者分为选择性希氏束起搏组20例(仅夺获希氏束)和非选择性希氏束起搏组10例(夺获希氏束和希氏旁心室组织)。采用三维标测系统指导下的希氏束起搏手术时间平均为113 min。术中X线曝光时间:选择性希氏束起搏组为(6.20±4.02)min,非选择性希氏束起搏组为(5.30±4.59)min,两者差异无统计学意义(P=0.60),其中有4例患者为完全零射线手术。术中测试参数:选择性希氏束起搏组阻抗平均为(666.50±81.00)Ω,感知平均为(3.30±0.63)mV,阈值平均为(1.80±0.50)V;非选择性希氏束起搏组阻抗平均为(598.00±112.33)Ω,感知平均为(7.40±0.99)mV,阈值平均(1.21±0.41)V,两组在阻抗、感知、阈值方面比较P值分别为0.065、<0.050、0.003,提示选择性希氏束起搏组和非选择性希氏束起搏组在感知、阈值方面的差异有统计学意义,选择性希氏束起搏组具有更低的感知以及更高的阈值。术后6个月随访患者希氏束导线的参数相对稳定。结论三维标测系统指导希氏束起搏植入可实现几乎"零X线曝光量",植入参数理想,效果稳定,是一种可行的手术方式。

Permanent His pacing guided by three-dimension mapping system

Objective To investigate the feasibility and effect of His bundle pacing(HBP)guided by three-dimension mapping system.Method Thirty patients underwent permanent His pacing through three-dimension mapping system were enrolled in this study.The average age of study group was 59.2 years,with 17 male patients.Factors including the whole procedure time,the X-ray exposure time,the lead parameters,the QRS duration before and after operation were analyzed by SPSS.Results The study group were divided into selective HBP(only capture His bundle)and non-selective HBP(capture both His bundle and Para-Hisian ventricular tissue).The average whole procedure time of permanent His pacing guided by three-dimension mapping system was 113 min,with the X-ray exposure of selective HBP and non-selective HBP was(6.20±4.02)min and(5.30±4.59)min,respectively.The statistical analysis of X-ray exposure was no difference in two groups.The lead parameters was programmed in selective HBP group as followings:the average impedance was(666.5±81.00)Ω,the average sense was(3.30±0.63)mV,and the average threshold was(1.80±0.50)V,respectively.While in non-selective HBP group,the average impedance was(598.00±112.33)Ω,with the average sense(7.40±0.99)mV and the average threshold was(1.21±0.41)V.The P value of impedance,sense,and threshold between two groups was 0.065,<0.05 and 0.003,respectively.The selective HBP group had higher threshold and lower sense than non-selective HBP group.Conclusion The permanent His pacing guided by three-dimension mapping system was feasible clinically in decreasing X-ray exposure time,and achieving perfect lead parameters.