Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
Department of Cardiology, The First People's Hospital of Yancheng, Fourth Affiliated Hospital of Nantong University, 166 Yulong Road, Yancheng 224005, China.
Europace. 2018 Jun 1;20(6):1010-1017. doi: 10.1093/europace/eux120.
This study aimed to assess the acute effect of selective His bundle pacing (S-HBP), non-selective His bundle pacing (NS-HBP), and right ventricular septum pacing (RVSP) on electrical synchrony and left ventricular (LV) mechanical synchrony using electrocardiogram and phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).
Totally 39 patients eligible for pacemaker were enrolled. Thirty-seven patients underwent successful His bundle pacing (HBP) including S-HBP in 23 and NS-HBP in 14 patients, respectively. Thirty-one patients simultaneously underwent backup RVSP. Twenty-three patients received SPECT MPI scans under different pacing modes, including S-HBP low- and high-output, NS-HBP low- and high-output, and RVSP mode. The paced QRS duration (QRSd) in the S-HBP low- and high-output mode and in the NS-HBP high-output mode were similarly compared with the baseline intrinsic QRSd. QRS duration in the NS-HBP low-output mode was slightly longer than the baseline. QRS duration was the longest in the RVSP group. Left ventricular mechanical synchrony parameters in both the S-HBP and the NS-HBP groups were remarkably better than those in the RVSP group. Moreover, LV mechanical synchrony parameters were much better in the S-HBP groups and NS-HBP high-output group.
Selective His bundle pacing and high-output NS-HBP could restore normal electrical and LV mechanical synchrony.
本研究旨在通过心电图和门控单光子发射计算机断层扫描（SPECT）心肌灌注显像（MPI）相位分析评估希氏束选择性起搏（S-HBP）、非选择性希氏束起搏（NS-HBP）和右室间隔部起搏（RVSP）对电同步和左心室（LV）机械同步的急性影响。
共纳入 39 名符合起搏器适应证的患者。37 名患者成功进行了希氏束起搏（HBP），其中 23 名患者进行了 S-HBP，14 名患者进行了 NS-HBP。31 名患者同时进行了后备 RVSP。23 名患者在不同起搏模式下接受 SPECT MPI 扫描，包括 S-HBP 低输出和高输出、NS-HBP 低输出和高输出以及 RVSP 模式。S-HBP 低输出和高输出模式以及 NS-HBP 高输出模式下的起搏 QRS 时限（QRSd）与基础固有 QRSd 相似。NS-HBP 低输出模式下的 QRSd 略长于基础值。在 RVSP 组中，QRSd 最长。S-HBP 和 NS-HBP 组的左心室机械同步参数明显优于 RVSP 组。此外，S-HBP 组和 NS-HBP 高输出组的 LV 机械同步参数更好。
选择性希氏束起搏和 NS-HBP 高输出可恢复正常的电和 LV 机械同步。
