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第44卷第10期                           南京医科大学学报(自然科学版)
                 2024年10月                   Journal of Nanjing Medical University(Natural Sciences)     ·1377 ·


               ·临床研究·

                左心室室间隔瘢痕对左束支起搏术实现左束支夺获的影响



                殷   凡 ,施夏韵 ,刘王琰 ,徐 怡 ,王云飞 ,王                 垚 ,朱晓梅    1*
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                南京医科大学第一附属医院放射科,心血管内科,江苏                    南京 210029
                1                           2
               [摘   要] 目的:通过心脏磁共振探索室间隔瘢痕对左束支起搏实现左束支夺获的影响。方法:回顾性分析52例拟接受左束
                支起搏的患者,根据是否实现左束支夺获分为失败组和成功组,并通过心脏磁共振对室间隔瘢痕分节段进行评分。结果:上室
                间隔瘢痕评分是预测左束支夺获成功与否的独立预测因子。当上室间隔的瘢痕<25%,左束支夺获的成功率为100%。而当瘢
                痕≥50%,左束支夺获的失败率为100%。结论:采用心脏磁共振评估上室间隔瘢痕有助于预测左束支起搏手术成功与否,为手
                术的顺利实施提供可靠的参考依据。
               [关键词] 左束支起搏;瘢痕评分;左室室间隔;左束支夺获;心脏磁共振
               [中图分类号] R445.2                   [文献标志码] A                      [文章编号] 1007⁃4368(2024)10⁃1377⁃06
                doi:10.7655/NYDXBNSN240610


                Effect of ventricular septal scars on the capture of left bundle branch during left bundle

                branch pacing
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                YIN Fan ,SHI Xiayun ,LIU Wangyan ,XU Yi ,WANG Yunfei ,WANG Yao ,ZHU Xiaomei 1*
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                Department of Radiology,Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,
                Nanjing 210029,China
               [Abstract] Objective:To investigate the effect of ventricular septal scars on the capture of left bundle branch during left bundle
                bracn pacing(LBBP)by cardiac magnetic resonance imaging(CMR). Methods:A retrospective analysis was conducted on 52 patients
                intendea for LBBP,who were divided into a failure group and a success group based on whether the capture of left bundle branch was
                achieved. Segmental score of septal scarring was performed using CMR. Results:The score of the upper ventricular septal scar was an
                independent predictor of the success of LBBP capture. When the scar of the upper ventricular septum was less than 25%,the success
                rate of LBBP capture was 100%. Howerver,when the scar was equal to or more than,the failure rate of LBBP capture was 100%.
                Conclusion:Evaluating upper ventricular septal scars using CMR helps predict the success of LBBP capture,providing a reliable
                reference for the smooth execution of the surgery.
               [Key words] left bundle branch pacing;the scores of scars;the ventricular septum;the capture of left bundle branch;cardiac magnetic
                resonance imaging
                                                                            [J Nanjing Med Univ,2024,44(10):1377⁃1382]




                    传导阻滞是一种异常的心电传导活动,可能导致                         72%的传导阻滞患者获得临床改善;起搏成功的标
                                     [1]
                心室重构与心功能降低 。左束支起搏(left bundle                     准主要为实现左束支夺获,即在起搏植入过程中测
                branch pacing,LBBP)作为新兴的起搏技术,以较低                  试电生理发现脉冲⁃左峰达到时间缩短≥10 ms,则可
                的起搏阈值及高 R 波感知优于双腔起搏,可使约                           判断夺获成功       [2-4] 。但既往研究发现室间隔总体瘢
                                                                  痕负荷较高的患者未能成功实现左束支夺获而导
               [基金项目] 国家自然科学基金(82302163);南京医科大学
                                                                  致LBBP手术失败       [5-6] 。同时也有研究表明双腔起搏
                第一附属医院青年学者培养基金(PY2022036)
                                                                  时左室导线电极头周围的瘢痕与术后改善不良相
                ∗
                通信作者(Corresponding author),E⁃mail:xiaomeizhu@njmu.edu.
                                                                    [7]
                cn                                                关 。LBBP 手术导线头端一般位于基底部及中部
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