摘要
目的探究左束支区域起搏(LBBAP)对心脏起搏器植入术患者心腔及心功能的影响。方法选择2022年1月至2024年6月于成都市第三人民医院收治的心脏起搏器植入术患者资料进行回顾性分析,根据心脏起搏电极植入部位不同分为右心室起搏(RVAP)组(采取传统RVAP)和LBBAP组(采取LBBAP),应用倾向性评分匹配法(卡钳值为0.01,比例1∶1),每组各83例。比较两组术后即刻、术后7 d、6个月和1年起搏参数(感知、阻抗、阈值)变化,术后即刻、术后1个月、6个月和1年心室房室同步性指标[左心室充盈时间/心动周期比值(LVFT/RR)心电图QRS波时限]变化。对比两组术前、术后6个月和1年超声心动图指标[左心室射血分数(LVEF)、左室舒张末径(LVEDD)、左心房内径)]、心功能分级变化,并统计两组并发症情况。结果起搏感知在组间、时间点、交互水平比较,阈值、阻抗的交互、组间水平比较,差异均无统计学意义(P>0.05),阈值、阻抗的时间水平比较,差异有统计学意义(P<0.050);LVFT/RR、QRS波时限在组间、时间点、交互水平比较,差异均有统计学意义(P<0.050),LBBAP组术后1个月、6个月和1年LVFT/RR、QRS波时限、Ts-LV-RV均低于RVAP组(P<0.050),Ts-LV-RV在组间、时间点比较,差异均有统计学意义(P<0.050);术后1年,两组患者LVEDD均低于术后即刻,差异有统计学意义(P<0.050);术后6个月和1年,两组NYHA分级均优于术前(P<0.050),且LBBAP组优于RVAP组(P<0.050);两组术后均未出现切口出血、囊袋积血及感染、电极移位、死亡。结论LBBAP应用于心脏起搏器植入患者,可有效改善机械同步性,进而改善患者的心功能。
Objective To explore the influence of left bundle branch area pacing(LBBAP)on cardiac chamber and cardiac function in patients undergoing cardiac pacemaker implantation.Methods The data of patients underwent cardiac pacemaker implantation was retrospectively analyzed in Chengdu Third People’s Hospital from Jan.2022 to June 2024.According to the different implantation sites of cardiac pacing electrodes,the patients were divided into right ventricular apical pacing(RVAP)group(underwent traditional RVAP)and LBBAP group(underwent LBBAP).Propensity score matching was adopted(with a caliper value of 0.01 and a matching ratio of 1:1),and 83 cases were enrolled in each group.The changes in pacing parameters(sensing,impedance,threshold)immediately after surgery,at 7 d,6 months,and 1 y postoperatively,as well as the changes in ventricular atrioventricular synchrony indicators[the ratio of left ventricular filling time to cardiac cycle(LVFT/RR),electrocardiogram QRS complex duration]immediately after surgery,at 1 month,6 months,and 1 y postoperatively were compared between 2 groups.The changes in ECG parameters[left ventricular ejection fraction(LVEF),left ventricular enddiastolic diameter(LVEDD),left atrial diameter(LAD)]and cardiac function classification were compared between 2 groups before surgery and 6 months and 1 y after surgery,and the incidence of complications was statistically analyzed in both groups.Results There were no statistically significant differences in pacing sensing between groups,at different time points,and at interaction level(P>0.05).For pacing threshold and impedance,no statistically significant differences were observed at the interaction and inter-group levels(P>0.05),while the differences at the time level were statistically significant(P<0.050).There were statistically significant differences in LVFT/RR and QRS complex duration between groups,at different time points,and at interaction level(P<0.050).LVFT/RR,QRS complex duration and Ts-LV-RV were lower in LBBAP group than those in RVAP group at 1 month,6 months and 1 y after surgery(P<0.050).There were statistically significant differences in Ts-LVRV between groups and at different time points(P<0.050).At 1 y after surgery,LVEDD was lower than that immediately after surgery(P<0.050).At 6 months and 1 y after surgery,NYHA classification was superior to that before surgery(P<0.050),and was superior in LBBAP group to that in RVAP group(P<0.050).There were no incision bleeding,pocket hematoma,infection,electrode displacement,or death occurred in either group after surgery.Conclusion The application of LBBAP can effectively improve the mechanical synchronicity,and then enhance heart function in patients with cardiac pacemaker implantation.
作者
李祚灵
裴晓玲
林艳
龙娇
杨洋
LI Zuoling;PEI Xiaoling;LIN Yan;LONG Jiao;YANG Yang(Catheterization Laboratory,Department of Cardiology,Chengdu Third People’s Hospital,Chengdu,610000,China)
出处
《中国循证心血管医学杂志》
2026年第1期37-42,共6页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
国家自然科学基金(8227020778)。
关键词
左束支区域起搏
心脏起搏器植入
右心室起搏
心功能
left bundle branch area pacing
cardiac pacemaker implantation
right ventricular pacing
heart function
