Zanon Francesco, Bacchiega Enrico, Rampin Lucia, Aggio Sivio, Baracca Enrico, Pastore Gianni, Marotta Tiziana, Corbucci Giorgio, Roncon Loris, Rubello Domenico, Prinzen Frits W
Division of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140, 45100 Rovigo, Italy.
Europace. 2008 May;10(5):580-7. doi: 10.1093/europace/eun089. Epub 2008 Apr 11.
The His bundle is regarded as the most physiological site for ventricular pacing, in that it avoids the adverse effects of right ventricular apical pacing (RVAP). However, very few studies have compared the effects of direct His bundle pacing (DHBP) and RVAP. The aim of our study was the intra-patient comparison of myocardial perfusion corresponding to these two different pacing techniques, as perfusion expresses local workload and is related to long-term outcome.
Twelve consecutive patients with standard pacemaker indication (9 male, 74 +/- 9 years) entered the study. Pacing leads were implanted in the right ventricular apex and directly in the His bundle, and were connected to different ports of the pacemaker. All patients first underwent 3 months of DHBP, followed by 3 months of RVAP. At the end of each 3-month period, myocardial perfusion was measured at rest using scintigraphy with Tc99m-SestaMIBI. The average values of perfusion were evaluated on a 20-segment basis. All patients also underwent clinical evaluation, echocardiography, and tissue Doppler imaging (TDI), to measure dyssynchrony, and a blood sample was taken for brain natriuretic peptide (BNP) assay. The perfusion score during DHBP pacing was significantly better than during RVAP (0.44 +/- 0.5 vs. 0.71 +/- 0.53, respectively; P = 0.011). None of the patients showed lower perfusion during DHBP than during RVAP. We found no significant difference in NYHA class, ventricular volumes, ejection fraction, or plasmatic BNP between DHBP and RVAP. However, mitral regurgitation (0.26 +/- 0.21 vs. 0.37 +/- 0.25; P < 0.001) and dyssynchrony (13.75 +/- 4.28 vs. 22.02 +/- 8.44; P = 0.008) were significantly less during DHBP than during RVAP.
Direct His bundle pacing is superior to RVAP in preserving the physiologic distribution of myocardial blood flow and reducing mitral regurgitation and left ventricular dyssynchrony.
希氏束被认为是心室起搏最符合生理的部位，因为它可避免右心室心尖部起搏（RVAP）的不良影响。然而，很少有研究比较直接希氏束起搏（DHBP）和RVAP的效果。我们研究的目的是在同一患者体内比较这两种不同起搏技术对应的心肌灌注情况，因为灌注反映局部工作负荷且与长期预后相关。
连续12例有标准起搏器植入指征的患者（9例男性，年龄74±9岁）进入本研究。起搏电极分别植入右心室心尖部和直接植入希氏束，并连接到起搏器的不同端口。所有患者先接受3个月的DHBP，随后接受3个月的RVAP。在每个3个月周期结束时，使用锝99m-甲氧基异丁基异腈闪烁显像术测量静息状态下的心肌灌注。灌注平均值在20节段基础上进行评估。所有患者还接受了临床评估、超声心动图检查和组织多普勒成像（TDI）以测量不同步情况，并采集血样进行脑钠肽（BNP）检测。DHBP起搏期间的灌注评分显著优于RVAP期间（分别为0.44±0.5和0.71±0.53；P = 0.011）。没有患者在DHBP期间的灌注低于RVAP期间。我们发现DHBP和RVAP在纽约心脏协会（NYHA）分级、心室容积、射血分数或血浆BNP方面没有显著差异。然而，DHBP期间的二尖瓣反流（0.26±0.21对0.37±0.25；P < 0.001）和不同步情况（13.75±4.28对22.02±8.44；P = 0.008）明显少于RVAP期间。
直接希氏束起搏在维持心肌血流的生理分布以及减少二尖瓣反流和左心室不同步方面优于RVAP。
