摘要
目的通过单中心分析,探讨希氏束起搏(His bundle pacing,HBP)的中长期有效性与安全性。方法纳入2017年4月至2018年8月在复旦大学附属中山医院心内科尝试行HBP的患者40例,进行前瞻性观察性研究,随访HBP术后1、3、6、12个月阈值、感知、阻抗及对患者心脏功能的影响。结果拟行HBP的患者40例,其中3例因术中阈值较高放弃HBP起搏,改为常规右室起搏,成功HBP的患者37例(占92.5%),其中心功能正常患者19例,术前平均QRS波时限(94.37±14.06)ms,HBP后QRS波时限为(100.74±14.62)ms,差异无统计学意义(P=0.18);心功能不全患者18例,术前平均QRS波时限(150.56±35.63)ms,HBP后QRS波时限缩短为(136.83±22.47)ms,差异无统计学意义(P=0.08)。术中及术后1、3、6、12个月后随访希氏束导线阈值分别为(1.26±0.52)V/0.4ms、(1.17±0.66)V/0.4ms、(1.34±0.87)V/0.4ms、(1.33±0.89)V/0.4ms、(1.33±0.85)V/0.4ms,与术中测试相比无统计学差异(P>0.05)。随访1年阈值升高>2.5V/0.4ms者4例(4/37,10.8%),无一例发生起搏导线移位、重置或拔除,无起搏系统感染,心功能不全患者中有1例因突发心室颤动死亡。心功能不全患者中,HBP术后1年NYHAⅢ-IV级患者比例较术前下降(P=0.02),左室射血分数较术前升高(0.39±0.15)vs(0.34±0.06),但差异无统计学意义(P=0.08)。结论HBP成功率高,中长期有效性与安全性较好,特别是对于心室起搏依赖合并心功能不全的心房颤动患者,HBP联合双室起搏(作为备份或融合起搏)可改善临床心功能,可能是一种合理选择。
Objective To investigate the mid-long term efficacy and safety of permanent His-bundle pacing(HBP).Methods In a prospective study,40patients with pacemaker indications attempted to HBP were enrolled in this study in Zhongshan Hospital of Fudan University from April 2017to August 2018.HBP threshold,R wave sensing,impedance,pacing ratio and cardiac function were measured during baseline and 1,3,6and 12months after implantation.Results Totally 37out of 40patients underwent successful permanent HBP.The other 3patients were changed to ventricular pacing instead of HBP as high lead threshold during implantation.Among 19patients with normal heart function,QRS durations after HBP were not significantly different compared with intrinsic QRS duration[(100.74±14.62)ms vs(94.37±14.06)ms,P=0.18].Among 18heart failure patients with reduced left ventricular ejection function(HFrEF),QRS durations were shorter after HBP than intrinsic QRS duration,but without significant differences[(136.83±22.47)ms vs(150.56±35.63)ms,(P=0.08)].The pacing thresholds of 37 patients with HBP at baseline,1,3,6and 12months follow-up were(1.26±0.52)V/0.4ms,(1.17±0.66)V/0.4ms,(1.34±0.87)V/0.4ms,(1.33±0.89)V/0.4ms,(1.33±0.85)V/0.4ms,respectively.Pacing threshold at 1-year follow-up was not significantly higher than that at baseline(P>0.05).Overall,high pacing threshold at 12-month follow-up occurred in 4patients(4/37,10.8%).No patients with loss of capture,lead dislodgement,revision or removal was found.Only 1patient in HFrEF group died because of ventricular fibrillation.The percentages of NYHA classⅢ-IV after 1year were significantly declined than baseline(P=0.02)while the left ventricular ejection function were not significantly increased compared with the baseline in HFrEF group(0.39±0.15vs 0.34±0.06,P=0.08).Conclusion HBP has more mid-long term efficacy and safety with high success rate.Permanent HBP combined with biventricular pacing(as backup or fusion pacing)is feasible which might be the reasonable option to improve clinical heart function for atrial fibrillation with reduced left ventricular ejection function patients who has pacemaker indication.
作者
王尹曼
陈学颖
柏瑾
王蔚
汪菁峰
秦胜梅
梁义秀
陈海燕
宿燕岗
葛均波
WANG Yin-man;CHEN Xue-ying;BAI Jin;WANG Wei;WANG Jing-feng;QIN Sheng-mei;LIANG Yi-xiu;CHEN Hai-yan;SU Yan-gang;GE Jun-bo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中国心脏起搏与心电生理杂志》
2020年第5期442-446,共5页
Chinese Journal of Cardiac Pacing and Electrophysiology
