文章摘要
任 骋,姚云婕,李柯蓓,王 莉,盛宇峰,钱雪松,邹建刚.希浦系统不同部位起搏的临床应用初步经验[J].南京医科大学学报,2019,(6):811~817
希浦系统不同部位起搏的临床应用初步经验
Preliminary clinical experience of His⁃Purkinje system pacing
投稿时间:2019-03-12  
DOI:10.7655/NYDXBNS20190605
中文关键词: 左束支起搏  希氏束起搏  安全性  可行性
英文关键词: His bundle pacing  left bundle branch pacing  safety  feasibility
基金项目:张家港市科技局科技支撑计划科研项目(ZKS1610)
作者单位
任 骋 苏州大学附属张家港市第一人民医院心血管内科江苏 张家港 215600 
姚云婕 苏州大学附属张家港市第一人民医院心血管内科江苏 张家港 215600 
李柯蓓 苏州大学附属张家港市第一人民医院心血管内科江苏 张家港 215600 
王 莉 苏州大学附属张家港市第一人民医院心血管内科江苏 张家港 215600 
盛宇峰 苏州大学附属张家港市第一人民医院心血管内科江苏 张家港 215600 
钱雪松 苏州大学附属张家港市第一人民医院心血管内科江苏 张家港 215600 
邹建刚 南京医科大学第一附属医院心血管内科江苏 南京 210029 
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中文摘要:
      目的:观察希氏束起搏(His bundle pacing,HBP)和左束支区域起搏(left bundle branch pacing,LBBP)的可行性和安全性。方法:选取2017年5月—2018年11月具有起搏器植入适应证的患者59例,其中19例行HBP,20例行LBBP,20例行传统右室间隔部起搏(right ventricular septum pacing,RVSP)。根据记录术中心腔内电图和起搏的体表心电图特征,分别定义HBP和LBBP;观察LBBP组和HBP组的起搏参数,包括阈值、R波感知、阻抗,评价LBBP和HBP的可行性和安全性,比较3组起搏的QRS波时限。结果:HBP、LBBP和RVSP的手术成功率分别为79%、95%和100%。术后随访3个月,3组的起搏参数包括阈值、R波感知、阻抗稳定;LBBP组R波感知较HBP组高[(17.01 ± 5.81)mV vs.(4.12 ± 3.86)mV,P<0.05];阈值较HBP组低[(0.66 ± 0.17)V vs.(1.49 ± 0.75)V,P<0.05];HBP、LBBP与RVSP组起搏的QRS波时限分别为(107.18 ± 9.97)ms、(107.77 ± 13.46)ms和(168.00 ± 8.42)ms,HBP和LBBP组的起搏QRS时限明显短于RVSP组(P<0.05);随访期间未发现导线阈值升高、移位或脱位现象。结论:初步证实了希浦系统起搏的可行性、安全性;LBBP与HBP相比,R波感知、阈值更佳,手术成功率更高;与传统右室起搏相比,希浦系统起搏能维持更生理性的心脏电同步性。
英文摘要:
      Objective:This study aims to explore the feasibility and safety of his bundle pacing(HBP)and left bundle branch pacing(LBBP). Methods:Fifty?nine patients with cardiac pacing were enrolled in the study between May 2017 to Nov. 2018. HBP were performed in group of 19 patients. LBBP were performed in that of 20. Additionally,another 20 patients received right ventricular septum pacing(RVSP). The successful HBP and LBBP were defined by the characteristic intra?electrocardiograph and paced surface QRS morphology,respectively. The feasibility and the short?term safety of the LBBP’s and HBP’s approach were evaluated. The pace QRS duration was compared among three groups. Results:The successful implanting rates of three different approaches were 79% in HBP group,95% in LBBP group and 100% in RVSP group. The pacing parameters of 3 groups were stable during 3?month follow up. The sensitivity of R wave and pacing threshold in LBBP group seems better than those in HBP group. The pace QRS duration was similar between HBP and LBBP groups;however,the paced QRS duration in RVSP group was significantly broader than those in HBP and LBBP group. Neither complication occurred during this procedure nor in those of follow?up. Conclusion:HBP and LBBP appear to be safe and feasible. LBBP demonstrated with a better sensitivity of R wave and threshold than HBP. Compared to RVSP,HBP and LBBP could maintain better cardiac synchrony.
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