Objective To compare the efficacy of left bundle branch pacing(LBBP)and right ventricular apical pacing(RVAP)in the treatment of elderly patients with atrioventricular block(AVB).Methods The clinical data of 256 patients aged ≥65 years with atrioventricular block who underwent permanent pacemaker implantation in Shanghai Tenth people's Hospital from January 2016 to June 2021 were retrospectively analyzed,including 121 cases treated with RVAP and 135 cases treated with LBBP.The clinical efficacy was compared between the two groups.Results There was no significant statistical difference in baseline data between the two groups.There were no significant difference in the pacing parameters,including threshold,perception and impedance,between the two groups during operation,7 d after operation,and 1 year after operation(all P＞0.05),while the postoperative QRS complex after operation in in the LBBP group was significantly shortened(all P＜0.001).During the 1 year follow-up,compared with RVAP group,the cardiac function of patients,including ventricular ejection fraction,left ventricular end-diastolic diameter and serum NT-proBNP level,was significantly better improved in LBBP group(all P＜0.05).In addition,there was no significant difference in the incidence of complications and the proportion of pacemaker-dependent patients between two groups(both P＞0.05).The rate of readmission within 1 year after surgery in LBBP group was significantly lower(P=0.004),which was confirmed by Logistic regression analysis(entry model P=0.014,forward stepwise model P=0.010).Kaplan-Meier cumulative event curves showed a statistically significant difference in the cumulative hospital readmission between RVAP and LBBP(P=0.003).ROC curve analysis also revealed that pacing methods had a predictive value for the readmission rate of elderly AVB patients(AUC=0.703,P=0.011)with a sensitivity of 0.857 and specificity of 0.550.Conclusion Compared with traditional RVAP,LBBP pacing in the treatment of elderly patients with AVB has good safety and stability,can effectively improve the cardiac function of patients,and reduce the rate of readmission,which is worthy of clinical promotion.
关键词
左束支起搏/右室心尖部起搏/老年/房室传导阻滞
Key words
left bundle branch pacing/right ventricular apical pacing/elderly/atrioventricular block
维普
万方数据