左束支起搏对III度房室传导阻滞患者远期疗效及安全性评估

Long-Term Efficacy and Safety Evaluation of Left Bundle Branch Pacing in Patients with Third-Degree Atrioventricular Block

摘要: 目的：旨在探索左束支起搏(LBBP)对III度房室传导阻滞患者的远期疗效及安全性。方法：选取2019-01-01至2019-06-31因III度房室传导阻滞于青岛大学附属医院就诊符合起搏适应症的患者50例，根据起搏部位的不同，随机分为LBBP组和右室间隔部起搏(RVSP)组，应用三维斑点追踪技术于术前、术后1年、术后2年采集患者左心室舒张末期容积(LVEDD)、收缩末期容积(LVESD)、射血分数(LVEF)、左心室16节段达最小收缩容积时间的标准差占心动周期的百分比值(Tmsv16-SD/R-R)，并随访2组患者的QRS波宽度、起搏参数及相关并发症。结果：1) 所有患者均成功起搏，全部患者术后长期随访导线参数稳定，均未出现感染、导线脱位、穿孔等并发症。2) LBBP组术后2年左束支起搏组QRS时限较术前无明显变化，且术后2年QRS时限明显短于RVSP组(P < 0.05)。3) LBBP组患者术后Tmsv16-SD/R-R较术前无明显变化，RVSP组术后Tmsv16-SD/R-R呈现上升趋势(P < 0.05)，且术后1年、术后2年LBBP组Tmsv16-SD/R-R明显低于RVSP组。4) 术后LBBP组患者LVEDD、LVESD、LVEF较术前无明显变化，RVSP组术后2年LVEDD、LVESD较术前增高(P < 0.05)，RVSP组术后2年LVEF较术前降低(P < 0.05)，术后2年LBBP组LVEF值明显高于RVSP组(P < 0.05)。结论：LBBP作为新兴的起搏方式，术后远期可保持良好的电机械同步性，且导线参数稳定。

Abstract: Objective: The objective is to investigate the long-term efficacy and safety of left bundle branch pacing (LBBP) in patients with third-degree atrioventricular block. Methods: A total of 50 patients who met the pacing indications due to third-degree atrioventricular block in the Affiliated Hospital of Qingdao University were selected and randomly divided into LBBP group and right ventricular septum pacing (RVSP) group according to different pacing sites. Three-dimensional speckle tracking technology was used to collect left ventricular end-diastolic volume (LVEDD), end-systolic volume (LVESD), ejection fraction (LVEF) and the standard deviation of the time to reach the minimum systolic volume of 16 segments of the left ventricle in the cardiac cycle (Tmsv16-SD/R-R) of patients before operation, 1 year after operation, and 2 years after operation. The QRS wave width, pacing parameters and related complications of the 2 groups of patients were followed up. Results: 1) All patients successfully paced. The lead parameters were stable after long-term follow-up. All patients had no complications such as infection, dislocation of lead wire, and perforation. 2) Two years after operation, the QRS duration of the LBBP group had no significant change compared with that before the operation, and the QRS duration of LBBP group was significantly shorter than that of RVSP group (P < 0.05). 3) The postoperative Tmsv16-SD/R-R of the LBBP group had no significant changes compared with that before the operation. The postoperative Tmsv16-SD/R-R of the RVSP group showed an upward trend (P < 0.05). Moreover, Tmsv16-SD/R-R in the LBBP group was significantly lower than that in the RVSP group at 1 year and 2 years after the operation. 4) LVEDD, LVESD, and LVEF in the LBBP group after surgery had no significant changes compared with those before surgery. In the RVSP group, LVEDD and LVESD were higher at 2 years after operation than before operation (P < 0.05). The LVEF in the RVSP group was lower than that before the operation 2 years after the operation (P < 0.05). The LVEF value of LBBP group was significantly higher than that of RVSP group 2 years after operation (P < 0.05). Conclusion: As a new pacing method, LBBP can maintain good electromechanical synchronization in the long term after operation. And the lead parameters of LBBP are stable.