直接左室间隔面起搏与传统右室心尖部起搏术式及疗效比较

Comparison of direct left ventricular septal pacing and traditional right ventricular apex pacing in patients with

关键词:  左室间隔面起搏  右室心尖部起搏  术式  效果

Key words:  left ventricular septal pacing  right ventricular apex pacing  operative method  effect

摘要:

目的比较直接左室间隔面起搏（direct left ventricular septal pacing, DLVSP）与右室心尖部起搏（right ventricular apical pacing, RVAP）两种电极植入方式及效果的差异。 方法入选2021年1月至2023年10月因高度及Ⅲ度房室传导阻滞入住苏州市吴中人民医院心内科安装心脏起搏器治疗患者，随机分为DLVSP组与RVAP组，每组各53例。比较两组基线情况、X线曝光时间、手术时间、并发症、起搏QRS波宽度、阈值和阻抗改变、心室起搏比例、B型钠尿肽（B-type natriuretic peptide, BNP）变化、左室射血分数（left ventricular ejection fraction, LVEF）改变指标。 结果两组在年龄、性别、合并症（高血压、高血糖、冠心病）、BNP、LVEF方面无差异。DLVSP术式组在X线曝光时间、电极植入总时长与RVAP组相比，差异无统计学意义。DLVSP术式组起搏成功率达92.45%（49/53），其中达到左束支起搏成功标准61.2%（30/49），左室间隔面心肌起搏38.8%（19/49）；起搏QRS波时限DLVSP组明显短于RVAP组（108.5±18.2ms vs 149.1±10.6ms，P<0.05）；随访电极阈值和阻抗稳定性两组无差别；术后6个月两组心室起搏比例无差异，RVAP组BNP水平显著高于DLVSP组[（278.2±23.6）pg/mL vs （201.7±28.2）pg/mL，P<0.05]，LVEF两组无差异。 结论DLVSP对有经验术者较传统RVAP不增加手术难度和时间，随访DLVSP术式对患者术后BNP增高有预防作用，可能降低远期临床心力衰竭发生的风险，可以作为心室起搏电极首选放置方法。

Abstract:

ObjectiveTo compare the application of direct left ventricular septal pacing(DLVSP) and right ventricular apical pacing(RVAP) in treatment of patients with severe atrioventricular block. MethodsA total of 106 patients with high and third degree atrioventricular block admitted to our department from January 2021 to October 2023 were randomly assigned to receive DLVSP or RVAP with 53 cases in each group. The baseline conditions, X-ray exposure time, operation time, complications, pacing QRS wave width, threshold and impedance changes, ventricular pacing ratio, B-type natriuretic peptide(BNP) levels, and left ventricular ejection fraction(LVEF) were compared between two groups. ResultsThere were no significant differences in age, gender, comorbidities(hypertension, hyperglycemia, coronary heart disease), BNP levels and LVEF between DLVSP group and RVAP group. There were no significant differences in X-ray exposure time and total electrode implantation time between two groups. The success rate of pacing in the DLVSP group reached 92.45%(49/53), with 61.2%(30/49) meeting the success criteria for left bundle branch pacing and 38.8%(19/49) for left ventricular septal myocardial pacing. The pacing QRS duration in the DLVSP group was significantly shorter than that in the RVAP group(108.5±18.2ms vs 149.1±10.6ms, P<0.05). There were no significant differences in electrode threshold and impedance stability between the two groups during follow-up. Six months after surgery, there was no significant difference in the proportion of ventricular pacing between the two groups. The BNP level in the RVAP group was significantly higher than that in the DLVSP group(278.2±23.6pg/mL vs 201.7±28.2pg/mL, P<0.05), while there was no significant difference in LVEF between the two groups. ConclusionDLVSP does not increase the difficulty and time of surgery for experienced surgeons compared to traditional RVAP. DLVSP also has a preventive effect on postoperative BNP elevation and it may reduce the risk of long-term clinical heart failure, indicating that DLVSP can be used as the preferred placement method for ventricular pacing electrodes.