左束支起搏对心室起搏依赖伴射血分数降低心力衰竭的长期疗效
Long-term effect of left bundle branch pacing on ventricular pacing dependence and heart failure with reduced ejection fraction
陈学颖 1金沁纯 1金亚伟 1邱楠 1王蔚 1秦胜梅 1柏瑾 1梁义秀 1汪菁峰 1宿燕岗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 探讨在心室起搏依赖伴射血分数降低的心力衰竭(HFrEF)患者中行左束支起搏的可行性和长期疗效.方法 本研究为前瞻性观察性研究,连续入选2019年1月至2021年12月在复旦大学附属中山医院心内科因心动过缓、预计心室起搏比例＞40％且左心室射血分数＜40％,行左束支起搏的患者.比较术前与术后QRS时限、起搏参数(阈值、感知和阻抗)、超声心动图参数的变化.结果 共入选35例HFrEF患者,年龄(69.0±13.1)岁,其中男26例.左束支起搏成功率为100％.随访(2.6±0.7)年,患者术后 QRS 时限较术前趋于改善[(142.9±46.4)ms 对(133.0±16.8)ms,P=0.088].术中和术后随访相比,患者起搏阈值、感知和阻抗均差异无统计学意义(P＞0.05).术前和术后随访相比,患者左心室射血分数(34.2％±5.1％对44.7％±12.6％,P＜0.000 1)、左心室舒张末期内径[(62.7±12.2)mm对(58.3±11.9)mm,P=0.002]、左心室收缩末期内径[(52.5±11.7)mm 对(47.5±13.4)mm,P=0.004]均显著改善,差异有统计学意义.结论 左束支起搏在心室起搏依赖伴HFrEF患者中成功率高,术后长期随访起搏参数稳定,心功能显著改善.
Abstract
Objective To explore the feasibility and long-term outcomes of left bundle branch pacing(LBBP)in patients with ventricular pacing dependence and heart failure with reduced ejection fraction(HFrEF).Methods This study was a prospective observational study.Patients indicated for LBBP due to bradycardia and an expected ventricular pacing ratio of＞40％with a left ventricular ejection fraction of＜40％in Department of Cardiology,Zhongshan Hospital,Fudan University between January 2019 and December 2021 were consecutively enrolled.The QRS duration,pacing parameters(thresholds,perception and impedance),and echocardiographic parameters were compared between baseline and during follow-up.Results A total of 35 HFrEF patients mean age(69.0±13.1)years,26 males,were enrolled,and all patients successfully underwent LBBP.The follow-up time was(2.6±0.7)years.The QRS duration trended towards improvement[(142.9±46.4)ms vs.(133.0±16.8)ms,P=0.088].Pacing parameters including thresholds,perception,and impedance all remained stable during follow-ups(P＞0.05).Significant difference was observed in left ventricular ejection fraction(34.2％±5.1％vs.44.7％±12.6％,P＜0.000 1),left ventricular end-diastolic internal diameter[(62.7±12.2)mm vs.(58.3±11.9)mm,P=0.002],and left ventricular end-systolic internal diameter[(52.5±11.7)mm vs.(47.5±13.4)mm,P=0.004]between baseline and during follow-up.Conclusion LBBP has a high success rate in patients with ventricular pacing dependence and HErEF,with stable pacing parameters and significant improvement in cardiac function at long-term follow-up.
关键词
心脏起搏器,人工/心力衰竭/左心室射血分数/心室起搏依赖/左束支起搏Key words
Pacemaker,artificial/Heart failure/Left ventricular ejection fraction/Ventricular pacing dependence/Left bundle branch pacing引用本文复制引用
基金项目
国家自然科学基金(82170387)
上海申康中心临床研究项目(SHDC2020CR4003)
复旦大学附属中山医院临床研究专项(2020ZSLC08)
出版年
2024
NETL
NSTL
万方数据