Cantù F, De Filippo P, Cardano P, De Luca A, Gavazzi A
Cardiology Unit, Cardiovascular Department, Ospedali Riuniti di Bergamo, Bergamo, Italy.
Pacing Clin Electrophysiol. 2006 Dec;29(12):1326-33. doi: 10.1111/j.1540-8159.2006.00543.x.
His Bundle (HB) pacing is a valid alternative to right ventricular pacing for patients with preserved His-ventricle conduction who are candidates for permanent stimulation. Permanent pacing in the HB area enables Selective HB pacing (SHBP) or para-Hisian pacing (PHP) to be achieved. The aim of our study was to draw up a set of easy criteria to differentiate and validate the two kinds of stimulations according to the pacing output and the ECG/EKG signals.
From February to July 2005, 17 patients eligible for a pacemaker (PM) procedure underwent implantation with the Medtronic SelectSecure lead (Medtronic, Minneapolis, MN, USA) screwed into the HB area.SHBP was defined when the intrinsic QRS was equal, in both duration and morphology, to the paced QRS, the His-Ventricular (H-V) interval was equal to Pace-Ventricular interval (Vp-V) and, at low output, only the HB was captured, while increasing the output resulted in both the HB and right ventricular (RV) being captured (widening of QRS at high output). Conversely, PHP was defined when the intrinsic QRS differed from the paced one, either in morphology or in duration and, at high output, both the RV and HB were captured (non-SHBP), while decreasing the output resulted in losing HB capture (widening of QRS at low output). According to these criteria, SHBP was achieved in 11 patients, while in the remaining 6, PHP was obtained. No adverse events were reported.
The above criteria enabled SHBP and PHP to be validated easily and clearly. A longer follow-up will be needed in order to ascertain whether the clinical outcome of these two approaches differs.
对于希氏束（HB）传导功能正常且适合永久起搏的患者，希氏束起搏是右心室起搏的有效替代方法。在HB区域进行永久起搏可实现选择性希氏束起搏（SHBP）或希氏束旁起搏（PHP）。我们研究的目的是制定一套简单的标准，根据起搏输出和心电图（ECG）信号来区分和验证这两种起搏方式。
2005年2月至7月，17例符合起搏器植入手术条件的患者植入了美敦力SelectSecure导线（美敦力公司，美国明尼阿波利斯），该导线拧入HB区域。当自身QRS波的时限和形态与起搏QRS波相等，希氏束-心室（H-V）间期等于起搏-心室间期（Vp-V），且在低输出时仅捕获到HB，而增加输出量会导致HB和右心室（RV）均被捕获（高输出时QRS波增宽）时，定义为SHBP。相反，当自身QRS波与起搏QRS波在形态或时限上不同，且在高输出时RV和HB均被捕获（非SHBP），而降低输出量会导致失去HB捕获（低输出时QRS波增宽）时，定义为PHP。根据这些标准，11例患者实现了SHBP，其余6例实现了PHP。未报告不良事件。
上述标准能够轻松、明确地验证SHBP和PHP。需要更长时间的随访以确定这两种方法的临床结果是否存在差异。
