Occhetta Eraldo, Bortnik Miriam, Magnani Andrea, Francalacci Gabriella, Piccinino Cristina, Plebani Laura, Marino Paolo
Divisione Clinicizzata di Cardiologia, Facoltà di Medicina e Chirurgia di Novara, Università degli Studi del Piemonte Orientale, Novara, Italy.
J Am Coll Cardiol. 2006 May 16;47(10):1938-45. doi: 10.1016/j.jacc.2006.01.056. Epub 2006 Apr 24.
The aim of our study was to evaluate the feasibility, the safety, and hemodynamic improvements induced by permanent para-Hisian pacing in patients with chronic atrial fibrillation and narrow QRS who underwent atrioventricular (AV) node ablation.
Right ventricular apical pacing, inducing asynchronous ventricular contraction, may impair cardiac function; permanent para-Hisian pacing could preserve interventricular synchrony and improve left ventricular function.
After AV node ablation, 16 patients were implanted with a dual-chamber pacemaker connected to a screw-in lead positioned in close proximity to the His bundle and to a right ventricular apical lead. Clinical and echocardiographic data were collected at baseline and after two randomized six-month periods (with para-Hisian and conventional pacing).
During para-Hisian pacing, the interventricular electromechanical delay improved as well (34 +/- 18 ms) as during right apical pacing (47 +/- 19 ms), p < 0.05. Para-Hisian pacing allowed an improvement in New York Heart Association functional class (1.75 +/- 0.4 vs. 2.33 +/- 0.6 at baseline and 2.5 +/- 0.4 during apical pacing, p < 0.05 for both), in quality-of-life score (16.2 +/- 8.7 vs. 32.5 +/- 15.0 at baseline, p < 0.05), and in the 6-min walk test (431 +/- 73 m vs. 378 +/- 60 m at baseline and 360 +/- 71 m during apical pacing, p < 0.5 for both). Mitral and tricuspid regurgitation improved during para-Hisian pacing (1.22 +/- 0.8 and 1.46 +/- 0.5 index, respectively, vs. 1.68 +/- 0.6 [p < 0.05] and 1.62 +/- 0.7 [p = NS] index at baseline, respectively), with a slight worsening during apical pacing (1.93 +/- 1 and 1.93 +/- 0.7 index, respectively, p < 0.05 for both).
Permanent para-Hisian pacing is feasible and safe. Compared with conventional right apical pacing, it allows an improvement in functional and hemodynamic parameters over long-term follow-up.
我们研究的目的是评估永久性希氏束旁起搏对慢性房颤且QRS波狭窄并接受房室（AV）结消融患者的可行性、安全性及血流动力学改善情况。
右心室心尖部起搏会导致心室收缩不同步，可能损害心脏功能；永久性希氏束旁起搏可维持心室间同步性并改善左心室功能。
在AV结消融后，16例患者植入双腔起搏器，该起搏器连接至靠近希氏束的螺旋电极及右心室心尖部电极。在基线及两个随机的六个月周期（分别采用希氏束旁起搏和传统起搏）后收集临床和超声心动图数据。
在希氏束旁起搏期间，心室间机电延迟改善情况（34±18毫秒）与右心室心尖部起搏期间（47±19毫秒）相似，p<0.05。希氏束旁起搏可改善纽约心脏协会心功能分级（基线时为1.75±0.4，心尖部起搏时为2.33±0.6，希氏束旁起搏时为2.5±0.4，两者均p<0.05）、生活质量评分（基线时为16.2±8.7，p<0.05）及6分钟步行试验结果（基线时为431±73米，心尖部起搏时为378±60米，希氏束旁起搏时为360±71米，两者均p<0.5）。希氏束旁起搏期间二尖瓣和三尖瓣反流改善（反流指数分别为1.22±0.8和1.46±0.5，而基线时分别为1.68±0.6 [p<0.05]和1.62±0.7 [p=无显著差异]），心尖部起搏期间则稍有恶化（反流指数分别为1.93±1和1.93±0.7，两者均p<0.05）。
永久性希氏束旁起搏是可行且安全的。与传统右心室心尖部起搏相比，长期随访显示其可改善功能和血流动力学参数。
