房室结消融联合左束支起搏治疗心房颤动合并心力衰竭的效果
Efficacy of atrioventricular node ablation combined with left bundle branch pacing in the treatment of atrial fibrillation complicated with heart failure
刘曦 1李骁 1张磊 1梁义秀 1柏瑾 1王蔚 1汪菁峰 1秦胜梅 1陈学颖 1宿燕岗 1葛均波1
作者信息
- 1. 复旦大学附属中山医院心内科 上海市心血管病研究所国家放射与治疗临床医学研究中心,上海 200032
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摘要
目的 探讨心房颤动(房颤)合并心力衰竭(心衰)患者中行房室结消融联合左束支起搏(LBBP)的可行性及治疗效果.方法 本研究为前瞻性观察研究,纳入2021年1月至2022年12月复旦大学附属中山医院心内科因房颤、药物控制心室率欠佳,采用房室结消融联合LBBP治疗的心衰患者,观察手术参数、起搏器参数及超声心动图参数等.结果 纳入30例患者,年龄(64.5±12.8)岁,其中男21例,心室率为(105.2±16.4)次/min.术中透视影像下LBBP导线与消融靶点间的距离为(22.8±5.3)mm.LBBP 术后起搏 QRS 时限较术前显著缩短[(128.9±10.2)ms 对(145.2±38.2)ms,P=0.030].起搏器参数方面,LBBP术后阈值为(0.9±0.3)V/0.4 ms,R波感知为(7.7±4.0)mV,阻抗为(537.5±72.8)Ω,阈值及R波感知在6个月随访时保持稳定,阻抗较前显著降低(P＜0.001),随访中未记录到阈值升高及起搏失夺获等并发症.术后6个月超声心动图随访显示,左心室射血分数(39.4％±6.5％对 31.4％±5.0％,P＜0.001)、左心室舒张末期内径[(64.4±8.5)mm 对(69.7±8.7)mm,P=0.019]及左心室收缩末期内径[(53.0±11.0)mm对(59.7±10.3)mm,P=0.022]较术前显著改善.结论 房室结消融联合LBBP可显著改善房颤伴心衰患者的心脏结构和功能,有望作为房颤心室率控制欠佳患者的有效治疗方法.
Abstract
Objective To investigate the feasibility and efficacy of atrioventricular node ablation combined with left bundle branch pacing(LBBP)in patients with atrial fibrillation(AF)and heart failure(HF).Methods This was a prospective observation study.From January 2021 to December 2022,patients with HF who were treated with atrioventricular node ablation combined with LBBP in Department of Cardiology,Zhongshan Hospital,Fudan University due to uncontrolled ventricular rate by drugs for AF were enrolled in this study.The procedural parameters,pacing parameters and cardiac structure and function were prospectively observed.Results A total of 30 patients were enrolled in this study,including 21 were male with an average age of(64.5±12.8)years old,ventricular rate of(105.2±16.4)bpm.The mean distance between the LBBP lead tip and the ablation target was(22.8±5.3)mm.The paced QRS duration of LBBP was(128.9±10.2)ms,which was significantly shorter than that before operation[(128.9±10.2)ms vs.(145.2±38.2)ms,P=0.030].In terms of pacing parameters,the pacing threshold was(0.9±0.3)V/0.4 ms,the R-wave sensing was(7.7±4.0)mV,and the impedance was(537.5±72.8)Ω.The pacing threshold and R-wave sensing were stable at 6-month follow-up,while the impedance was significantly decreased(P＜0.001).No complications such as increased pacing threshold and loss capture were recorded during follow-up.Echocardiographic parameters including left ventricular ejection fractiong(39.4％±6.5％vs.31.4％±5.0％,P＜0.001),left ventricular end diastolic diameter[(64.4±8.5)mm vs.(69.7±8.7)mm,P=0.019]and left ventricular end systolic diameter[(53.0±11.0)mm vs.(59.7±10.3)mm,P=0.022]were significantly improved at 6-months follow-up.Conclusion Atrioventricular node ablation combined with LBBP can significantly improve the cardiac structure and function of patients with AF and HF,and is expected to be an effective treatment for uncontrolled ventricular rate in atrial fibrillation.
关键词
心房颤动/心力衰竭/房室结消融/左束支起博/可行性/效果Key words
Atrial fibrillation/Heart failure/Atrioventricular node ablation/Left bundle branch pacing/Feasibility/Efficacy引用本文复制引用
基金项目
国家自然科学基金(82170387)
复旦大学附属中山医院青年基金(专培2022-007)
出版年
2024
NETL
NSTL
万方数据