Das Asit, Chatterjee Suman
Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India.
Heart Vessels. 2019 Sep;34(9):1552-1558. doi: 10.1007/s00380-019-01390-5. Epub 2019 Apr 8.
Several studies have reported the adverse effects of right ventricular apical pacing. Permanent His bundle pacing is proved to be the most physiological. But it can be technically difficult sometimes. One recent large multicenter randomized trial showed that pacing from left ventricular apex or mid-lateral wall has the greatest potential to prevent pacing-induced reduction of cardiac pump function (by maintaining left ventricular mechanical synchrony) and, therefore, can be considered as physiological site. In our study, we have wanted to see the outcome of left ventricular pacing through coronary sinus branch with active fixation bipolar lead as a routine pacing technique in patients with symptomatic left bundle branch block. In our study we have recruited 27 patients for left ventricular pacing through coronary sinus branch (as done in cardiac resynchronization therapy) with active fixation bipolar lead and 33 patients for right ventricular apical pacing (control) and compared left ventricular pacing with right ventricular apical pacing in patients with history of syncope with left bundle branch block in baseline electrocardiography who presented with atrio-ventricular block or prolonged HV interval (≥ 70 ms) on electrophysiology study in term of procedure and fluoroscopy time and short-term lead performance and left ventricular function. The results of our study showed that left ventricular pacing through a tributary of coronary sinus is associated with shortened QRS duration (21.10 ± 3.92 ms) and better LV function (higher left ventricular ejection fraction 64.00 ± 3.03 vs. 59.73 ± 6.73 and lower left ventricular diastolic internal diameter 4.58 ± 0.32 vs. 5.23 ± 0.40 cm) in comparison to right ventricular apical pacing. However, the total procedure time and fluoroscopy time was significantly higher (73.75 ± 11.02 vs. 63.32 ± 6.06 min and 7.08 ± 1.48 vs. 5.02 ± 1.39 min, respectively) in left ventricular pacing group. The results of this study indicate that transvenous left ventricular epicardial pacing may be an option for physiological pacing in patients with symptomatic left bundle branch block.
多项研究报告了右心室心尖部起搏的不良影响。永久性希氏束起搏被证明是最符合生理需求的。但有时在技术上会有困难。最近一项大型多中心随机试验表明，从左心室心尖部或中外侧壁起搏在预防起搏引起的心脏泵功能降低方面（通过维持左心室机械同步性）具有最大潜力，因此可被视为生理性起搏部位。在我们的研究中，我们想观察对于有症状的左束支传导阻滞患者，将通过冠状窦分支使用主动固定双极导线进行左心室起搏作为一种常规起搏技术的效果。在我们的研究中，我们招募了27例患者通过冠状窦分支进行左心室起搏（如同心脏再同步治疗那样）并使用主动固定双极导线，以及33例患者进行右心室心尖部起搏（作为对照），并在基线心电图有左束支传导阻滞且在电生理检查中出现房室传导阻滞或HV间期延长（≥70毫秒）的晕厥患者中，比较左心室起搏和右心室心尖部起搏在手术过程、透视时间、短期导线性能和左心室功能方面的差异。我们的研究结果表明，与右心室心尖部起搏相比，通过冠状窦分支进行左心室起搏与QRS波时限缩短（21.10±3.92毫秒）以及更好的左心室功能相关（左心室射血分数更高，分别为64.00±3.03与59.73±6.73，左心室舒张内径更低，分别为4.58±0.32与5.23±0.40厘米）。然而，左心室起搏组的总手术时间和透视时间显著更长（分别为73.75±11.02与63.32±6.06分钟，以及7.08±1.48与5.02±1.39分钟）。这项研究的结果表明，经静脉左心室心外膜起搏可能是有症状的左束支传导阻滞患者生理性起搏的一种选择。
