Gu Min, Hu Yiran, Hua Wei, Niu Hongxia, Chen Xuhua, Cai Minsi, Zhang Nixiao, Li Hui, Zhou Xiaohong, Zhang Shu
The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cardiovasc Electrophysiol. 2019 Oct;30(10):2164-2169. doi: 10.1111/jce.14140. Epub 2019 Aug 31.
His bundle pacing (HBP) is a physiological pacing modality, but HBP implantation remains a challenge.
This study explored the feasibility of using visualization of the tricuspid valve annulus (TVA) to locate the site for HBP.
During the lead placement in eight patients with symptomatic bradycardia, the TVA and tricuspid septal leaflet was revealed by contrast injection in the right ventricle under the fluoroscopic right anterior oblique view, and the target site for HBP was identified near the intersection of the tricuspid septal leaflet and the interventricular septum. On the basis of the imaging marker, the pacing lead was placed for HBP at either the atrial (aHBP) or ventricular side (vHBP).
During the implantation, the pacing lead placement was attempted for aHBP in two patients, vHBP in five patients, and first for aHBP then vHBP in one patient. The aHBP was selective and had a capture threshold of 1.6 ± 0.5 V@ 1.0ms and R-wave amplitude of 1.2 ± 0.4 mV. Ventricular-side His bundle capture was selective in four patients and nonselective in two patients. The vHBP capture threshold was 0.8 ± 0.4 V@ 1.0ms (P < .05 vs aHBP) and R-wave amplitude was 4.1 ± 1.5 mV (P < .05 vs aHBP). At the final pacing programming of 3.0 V@ 1.0ms, vHBP was nonselective in all six patients and aHBP remained selective in two patients. Pacing parameters remained stable at 3 months.
The location of the TVA and tricuspid septal leaflet revealed by right ventriculography can be used as a landmark to identify the HBP site.
希氏束起搏（HBP）是一种生理性起搏方式，但HBP植入仍然是一项挑战。
本研究探讨利用三尖瓣环（TVA）可视化定位HBP部位的可行性。
在8例有症状心动过缓患者放置导线过程中，通过在右前斜位透视下向右心室注射造影剂显示TVA和三尖瓣隔叶，在三尖瓣隔叶与室间隔的交点附近确定HBP的目标部位。基于该影像标记，在心房侧（aHBP）或心室侧（vHBP）放置用于HBP的起搏导线。
植入过程中，2例患者尝试进行aHBP起搏导线放置，5例患者尝试进行vHBP起搏导线放置，1例患者先尝试aHBP然后尝试vHBP。aHBP具有选择性，捕获阈值为1.6±0.5V@1.0ms，R波振幅为1.2±0.4mV。4例患者心室侧希氏束捕获具有选择性，2例患者无选择性。vHBP捕获阈值为0.8±0.4V@1.0ms（与aHBP相比，P<0.05），R波振幅为4.1±1.5mV（与aHBP相比，P<0.05）。在最终3.0V@1.0ms的起搏程控时，所有6例患者vHBP均无选择性，2例患者aHBP仍具有选择性。起搏参数在3个月时保持稳定。
右心室造影显示的TVA和三尖瓣隔叶的位置可作为识别HBP部位的标志。
