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ENGLISH ABSTRACT
永久左束支起搏心脏再同步治疗在左束支阻滞患者远期疗效的初步研究
吴圣杰
苏蓝
项文豪
郑茹洁
蔡蒙醒
徐蕾
方英
王良国
黄伟剑
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1007-6638.2019.05.004
Long-term benefits and feasibility of permanent left bundle branch pacing in patients with left bundle branch block
Wu Shengjie
Su Lan
Xiang Wenhao
Zheng Rujie
Cai Mengxing
Xu Lei
Fang Ying
Wang Liangguo
Huang Weijian
Authors Info & Affiliations
Wu Shengjie
Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, the Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou 325000, China
Su Lan
Xiang Wenhao
Zheng Rujie
Cai Mengxing
Xu Lei
Fang Ying
Wang Liangguo
Huang Weijian
·
DOI： 10.3760/cma.j.issn.1007-6638.2019.05.004
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摘要

目的评价左束支起搏（LBBP）在左束支传导阻滞（LBBB）患者中应用的可行性、安全性、同步及心功能改善。

方法收集2014年4月至2017年8月在温州医科大学附属第一医院心内科植入永久性LBBP，且随访时间超过2年的LBBB患者。讨论植入方法的可行性，分析与评估左束支夺获的电学特性及临床疗效，主要指标为QRS时限、阈值、感知、心功能，超声心动图结果及导线相关并发症。

结果共入选成功植入永久LBBP 11例，平均年龄（71.0±12.4）岁，年龄范围41~91岁。自身QRS时限为（164.6±15.7）ms，起搏QRS时限为（113.1±17.1）ms。随访（32.5±12.1）个月。急性期阈值为（0.65±0.21）V/0.5 ms，感知为（8.3±1.7）mV，在随访2年时，阈值及感知保持稳定，分别为（0.70±0.16）V/0.5 ms，（9.1±2.7）mV。其中7例左心室射血分数（LVEF）<50%，LVEF从基线的34.0%±8.2%提升到末次随访的63.4%±9.8%，左心室收缩末期容积从（127.6±65.3）ml缩小至（37.2±13.9）ml，心功能（NYHA分级）从（3.3±0.7）级恢复至（1.3±0.5）级（ P<0.05）。术后未观察到导线脱位、失夺获、阈值增高及心力衰竭再住院、死亡等不良事件。

结论永久LBBP纠正LBBB，实现左心室再同步，其远期阈值稳定、感知良好、安全可靠，显著改善患者心功能，可作为双心室起搏或希氏束起搏的补充与替代。

希氏束;心脏再同步治疗;束支传导阻滞
ABSTRACT

ObjectiveTo assess the long-term feasibility, safety and effectiveness of permanent left bundle branch pacing (LBBP) in patients with left bundle branch block (LBBB) .

MethodsPatients with LBBB who had implanted LBBP more than 2 years from Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University were included. The feasibility of the implantation method, the electrical characteristics and clinical efficacy of the left bundle branch were analyzed and evaluated. The main outcome measures were characteristics, QRS complex, pacing parameters, echocardiographic measurements, and New York Heart Association (NYHA) functional classification and electrode-related complications.

ResultsA total of 11 patients were included, with mean age of (71.0±12.4) years and intrinsic QRS duration of (164.6±15.7) ms. Of them, 6 (54.5%) were selective LBBP and 5 were non-selective, with the paced QRS duration of (113.1±17.1) ms. The average follow-up duration was (32.5±12.1) months. The acute threshold and R-wave amplitude were (0.65±0.21) V/0.5 ms and (8.3±1.7) mV, respectively, which remained stable during the follow-up. In 7 patients who had left ventricular ejection fraction (LVEF) <50%, the LVEF improved from 34.0%±8.2% to 63.4%±9.8%, left ventricular end-systolic volume decreased from (127.6±65.3) ml to (37.2±13.9) ml and NYHA improved from 3.3±0.7 to 1.3±0.5 ( P<0.05) . No adverse events such as electrode dislocation, loss of capture, increased threshold, perforation and stroke, rehospitalization for heart failure or death were observed.

ConclusionPermanent LBBP can achieve LV synchrony in LBBB patients and is safe and effective during long-term follow-up.

Bundle of His;Cardiac resynchronization therapy;Bundle branch block
Huang Weijian, Email: mocdef.6ab2196gnauhnaijiew
Copyright by Chinese Medical Association
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引用本文

吴圣杰,苏蓝,项文豪,等. 永久左束支起搏心脏再同步治疗在左束支阻滞患者远期疗效的初步研究[J]. 中华心律失常学杂志,2019,23(5)：399-404.

DOI:10.3760/cma.j.issn.1007-6638.2019.05.004

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双心室起搏是目前具有许多循证医学证据的心脏再同步治疗（CRT） [ 1 ]，其通过双或多部位心室起搏融合达到相对再同步，但仅在典型左束支传导阻滞（LBBB），QRS时限>150 ms的患者中能获得肯定的疗效 [ 2 , 3 ]，且不到70%患者冠状静脉窦（CS）导线能植入到最佳的部位，同时存在其他较高的并发症 [ 4 , 5 ]。希氏束起搏纠正LBBB，能实现真正的生理性再同步起搏 [ 6 , 7 ]，虽然植入设备及方法有所改进 [ 8 , 9 ]，手术成功率有了较大提升，但存在以下不足：高阈值、低感知、固定困难等 [ 6 , 10 ]。我中心在2017年报道了经静脉、穿间隔、左心室内膜下的左束支起搏（LBBP）技术 [ 11 ]，在保证左心室同步基础上，稳定且低的起搏阈值及良好的心室感知。与希氏束起搏相比，跨越传导束阻滞部位的LBBP在房室传导阻滞及LBBB患者中更具优势。本文对LBBP在LBBB患者同步治疗的远期疗效与安全性进行研究。
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参考文献
[1]
中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志， 2018，46(10)：760-789. DOI： 10.3760/cma.j.issn.0253-3758.2018.10.004 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Doshi RN , Gupta N . Cardiac resynchronization therapy: past, present, and future[J]. Rev Cardiovasc Med, 2007,8(2):69-77. DOI: 10.1016/j.hfc.2014.12.007 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Khidir MJ , Delgado V , Ajmone Marsan N ,et al. QRS duration versus morphology and survival after cardiac resynchronization therapy[J]. ESC Heart Fail, 2017,4(1):23-30. DOI: 10.1002/ehf2.12122 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Bulava A , Lukl J . Single-centre experience with coronary sinus lead stability and long-term pacing parameters[J]. Europace, 2007,9(7):523-527. DOI: 10.1093/europace/eum082 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Gamble JHP , Herring N , Ginks M ,et al. Procedural success of left ventricular lead placement for cardiac resynchronization therapy: a meta-analysis[J]. JACC Clin Electrophysiol, 2016,2(1):69-77. DOI: 10.1016/j.jacep.2015.08.009 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Huang W , Su L , Wu S ,et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block[J]. Heart, 2019,105(2):137-143. DOI: 10.1136/heartjnl-2018-313415 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Morina-Vazquez P , Barba-Pichardo R , Venegas-Gamero J ,et al. Cardiac resynchronization through selective His bundle pacing in a patient with the so-called InfraHis atrioventricular block[J]. Pacing Clin Electrophysiol, 2005,28(7):726-729. DOI: 10.1111/j.1540-8159.2005.00150.x .
返回引文位置Google Scholar
百度学术
万方数据
[8]
苏蓝，吴高俊，李海鹰，等. 3830导线在选择性心室起搏的应用及近期安全性观察[J]. 中国心脏起搏与心电生理杂志， 2014，28(3)：236-239. DOI： 10.13333/j.cnki.cjcpe.2014.03.014 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Su L , Wu S , Wang S ,et al. Pacing parameters and success rates of permanent His-bundle pacing in patients with narrow QRS: a single-centre experience[J]. Europace, 2019,21(5):763-770. DOI: 10.1093/europace/euy281 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
吴圣杰，苏蓝，黄伟剑. 希氏-浦肯野系统起搏的现状与展望[J]. 中华心律失常学杂志， 2018，22(2)：123-129. DOI： 10.3760/cma.j.issn.1007-6638.2018.02.007 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Huang W , Su L , Wu S ,et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block[J]. Can J Cardiol, 2017,33(12):1736e1-1736e3. DOI: 10.1016/j.cjca.2017.09.013 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Huang W , Chen X , Su L ,et al. A beginner’s guide to permanent left bundle branch pacing[J/OL]. Heart Rhythm, 2019, 10.1016/j.hrthm.2019.06.016 :S1547-5271（19）30573-9. https://linkinghub.elsevier.com/retrieve/pii/S1547-5271(19)30573-9. DOI:published online ahead of print June 22, 2019.[ ].
返回引文位置Google Scholar
百度学术
万方数据
[13]
El-Sherif N , Amay YLF , Schonfield C ,et al. Normalization of bundle branch block patterns by distal His bundle pacing. Clinical and experimental evidence of longitudinal dissociation in the pathologic his bundle[J]. Circulation, 1978,57(3):473-483. DOI: 10.1161/01.CIR.57.3.473 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Scherlag BJ , Kosowsky BD , Damato AN . A technique for ventricular pacing from the His bundle of the intact heart[J]. J Appl Physiol, 1967,22(3):584-587. DOI: 10.1152/jappl.1967.22.3.584 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Deshmukh P , Casavant DA , Romanyshyn M ,et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation[J]. Circulation, 2000,101(8):869-877. DOI: 10.1161/01.CIR.101.8.869 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
吴高俊，苏蓝，方丹红，等. 永久希氏束起搏临床应用[J]. 中华心律失常学杂志， 2012，16(4)：302-306. DOI： 10.3760/cma.j.issn.1007-6638.2012.04.005 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Shan P , Su L , Chen X ,et al. Direct His-bundle pacing improved left ventricular function and remodelling in a biventricular pacing nonresponder[J]. Can J Cardiol, 2016,32(12):1577. e1-1577.e4. DOI: 10.1016/j.cjca.2015.10.024 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Shan P , Su L , Zhou X ,et al. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50[J]. Heart Rhythm, 2018,15(3):405-412. DOI: 10.1016/j.hrthm.2017.10.031 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Sharma PS , Dandamudi G , Herweg B ,et al. Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: a multicenter experience[J]. Heart Rhythm, 2018,15(3):413-420. DOI: 10.1016/j.hrthm.2017.10.014 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Upadhyay GA , Cherian T , Shatz DY ,et al. Intracardiac delineation of septal conduction in left bundle branch block patterns: mechanistic evidence of left intra-Hisian block circumvented by His pacing[J]. Circulation, 2019,139(16):1876-1888. DOI: 10.1161/CIRCULATIONAHA.118.038648 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Elizari MV . The normal variants in the left bundle branch system[J]. J Electrocardiol, 2017,50(4):389-399. DOI: 10.1016/j.jelectrocard.2017.03.004 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Rickard J , Popovic Z , Verhaert D ,et al. The QRS narrowing indexpredicts reverse left ventricular remodeling following cardiacresynchronization therapy[J]. Pacing Clin Electrophysiol, 2011,34(5):604-611. DOI: 10.1111/j.1540-8159.2010.03022.x .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Wu S , Su L , Wang S ,et al. Peri-left bundle branch pacing in a patient with right ventricular pacing-induced cardiomyopathy and atrioventricular infra-Hisian block[J]. Europace, 2019,21(7):1038. DOI: 10.1093/europace/euz031 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Chen X , Wu S , Su L ,et al. The characteristics of the electrocardiogram and the intracardiac electrogram in left bundle branch pacing[J]. J Cardiovasc Electrophysiol, 2019,30(7):1096-1101. DOI: 10.1111/jce.13956 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Mafi-Rad M , Luermans JG , Blaauw Y ,et al. Feasibility and acute hemodynamic effect of left ventricular septal pacing by transvenous approach through the interventricular septum[J]. Circ Arrhythm Electrophysiol, 2016,9(3):e003344. DOI: 10.1161/CIRCEP.115.003344 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
黄伟剑，Email： mocdef.6ab2196gnauhnaijiew
B
所有作者均声明不存在利益冲突
C
浙江省重点研发项目 (2019C03012)
温州市科技局重大科技项目 (ZS2017010)
温州市基础性科研项目 (Y20180143)
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