查看更多>>摘要：目的 比较左束支区域起搏（LBBaP）与传统右心室起搏（RVP）对双腔起搏器植入术后患者左心功能的影响。 方法 本研究为回顾性队列研究。纳入2017年3月至2021年4月在首都医科大学北京安贞医院接受双腔起搏器植入术的患者，根据心室导线置入部位分为LBBaP组和RVP组。随访时间截至2022年3月，分别比较两组患者基线、随访期间的超声心动图检查结果、心电图测得的QRS宽度、起搏参数，并发症（心室电极穿孔、脱位、心包积液、三尖瓣穿孔等）发生率、发生时间。 结果 共纳入163例患者，年龄（68.3±13.5）岁，其中男性82例（50.3%）。LBBaP组80例，RVP组83例。LBBaP组患者的基线左心室舒张末期内径［（50.49±4.95）mm比（47.43±8.15）mm，P=0.01］、左心房内经［（33.14±5.94）mm比（30.18±3.92）mm，P=0.001］高于RVP组；随访时LBBaP组的左心房内径低于RVP组［（37.10±6.70）mm比（40.10±8.90）mm，P=0.016］。两组基线QRS宽度差异无统计学意义（P=0.490），LBBaP组术后QRS宽度小于RVP组［（110.69±24.01）ms比（139.65±29.85）ms，P<0.01］。LBBaP组术中阈值高于RVP组［（0.83±0.32）V/0.48 ms比（0.71±0.23）V/0.48 ms，P=0.004］、阻抗小于RVP组［（754.53±205.59）Ω比（905.41±302.75）Ω，P<0.01］；LBBaP组术后心室起搏比例［（87.39±20.92）%比（79.49±25.76）%，P=0.034］、阈值［（0.90±0.38）V/0.48 ms比（0.69±0.27）V/0.48 ms，P<0.01］高于RVP组，阻抗［（507.45±77.37）Ω比（620.52±197.29）Ω，P<0.01］低于RVP组。术后随访5~51个月，中位随访时间为17个月。LBBaP组与RVP组患者的并发症发生率差异无统计学意义［13.8%（11/80）比7.2%（6/83），P>0.05］；LBBaP组患者术后并发症发生时间早于RVP组［中位时间：29.74（95CI% 27.21~32.26）个月比46.17（95CI% 42.48~49.86）个月，P=0.030］。 结论 LBBaP的起搏参数更稳定，对临床左心功能改善更明显，但阈值相对高于RVP，且并发症出现时间相对较早。 Objective To compare the effects of left bundle branch area pacing (LBBaP) versus traditional right ventricular pacing (RVP) on left ventricular function in patients after dual-chamber pacemaker implantation. Methods A retrospective cohort study was conducted on patients who underwent dual-chamber pacemaker implantation from March 2017 to April 2021 in Beijing Anzhen Hospital. The patients were divided into the LBBaP group and RVP group based on the placement of the ventricular lead. Follow-up was conducted until March 2022, comparing baseline and follow-up echocardiographic parameters, pacing parameters, and the incidence and timing of complications between the two groups. The complications included ventricular electrode perforation, dislocation, pericardial effusion, tricuspid valve perforation, etc. Results A total of 163 patients aged (68.3±13.5) years were included, including 82 (50.3%) men, with 80 patients in the LBBaP group and 83 in the RVP group. Baseline left ventricular end-diastolic diameter ((50.49±4.95) mm vs. (47.43±8.15) mm, P=0.01) and left atrium (LA) ((33.14±5.94) mm vs. (30.18±3.92) mm, P=0.001) in the LBBaP group were significantly higher than those in the RVP group. Follow-up LA diameter ((37.10±6.70) mm vs. (40.10±8.90) mm, P=0.016) showed a statistically significant difference in the LBBaP group compared to the RVP group. There was no statistically significant difference between the two groups in baseline QRS duration(P=0.490). Postoperative QRS duration in the LBBaP group was significantly lower ((110.69±24.01) ms vs. (139.65±29.85) ms, P<0.010). Intraoperative threshold in the LBBaP group was significantly higher ((0.83±0.32) V/0.48 ms vs. (0.71±0.23) V/0.48 ms,P=0.004), while impedance was lower ((754.53±205.59) Ω vs. (905.41±302.75) Ω, P<0.01). Comparing with the RVP group, postoperative ventricular pacing ratio (VP) ((87.39±20.92) % vs. (79.49±25.76) %,P=0.034), threshold ((0.90±0.38) V/0.48 ms vs. (0.69±0.27) V/0.48 ms, P<0.01) in the LBBaP group were higher, and impedance ((507.45±77.37) Ω vs. (620.52±197.29) Ω,P<0.01) in the LBBaP group was lower. Postoperative follow-up period was 5 to 51 months, with a median follow-up time of 17 months. No statistically significant difference in overall complications between the LBBaP and RVP groups was found (13.8% (11/80) vs. 7.2% (6/83),P>0.05). The median time to occurrence of complications after surgery was significantly earlier in the LBBaP group (29.74 (95%CI 27.21-32.26) months vs. 46.17 (95%CI 42.48-49.86) months, P=0.030). Conclusion LBBaP demonstrates more stable pacing parameters, substantial improvement in clinical left ventricular function, with a relatively higher threshold compared to traditional RVP, and complications occurs relatively early.
万方数据