Fehske W, Israel C W, Winter S, Ghorbany P, Nguyen D Q, Voigt J-U
Klinik für Innere Medizin III (Kardiologie), St. Vinzenz-Hospital, Köln, Deutschland.
Klinik für Innere Medizin - Kardiologie, Nephrologie und Diabetologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland.
Herzschrittmacherther Elektrophysiol. 2020 Jun;31(2):151-159. doi: 10.1007/s00399-020-00686-8. Epub 2020 May 8.
In patients with pacemaker (PM) therapy, His bundle stimulation (HBS) may lead to a more synchronous activation of the left ventricle (LV) than conventional right ventricular stimulation (RVS). In this study, we investigated to which extent this effect can be objectified by means of contemporary echocardiographic functional imaging.
In all, 15 RVS patients (6 women, mean age 76.6 ± 4.1 years) and 15 HBS patients (6 women, mean age 74.6 ± 3.7 years) underwent echocardiography with and without cardiac pacing. Besides LV end-diastolic volume (EDV), ejection fraction (EF), and global strain (GLS), we measured global and regional myocardial work and LV efficiency based on noninvasive pressure-strain loops.
In all HBS patients, optimization of PM settings resulted in immediate changes in myocardial function parameters. With pacing, RVS patients showed a higher decrease in EF and GLS than HBS patients. Global LV work and LV work efficiency decreased significantly only in RVS patients.
Changes in regional and global myocardial function can by proven and quantified by functional echocardiography. In patients under PM therapy, HBS shows functional advantages in comparison to conventional RVS.
在接受起搏器（PM）治疗的患者中，希氏束刺激（HBS）可能比传统的右心室刺激（RVS）更能使左心室（LV）同步激活。在本研究中，我们调查了这种效应在多大程度上可以通过当代超声心动图功能成像来客观化。
共有15例接受RVS治疗的患者（6名女性，平均年龄76.6±4.1岁）和15例接受HBS治疗的患者（6名女性，平均年龄74.6±3.7岁）接受了有和没有心脏起搏的超声心动图检查。除了左心室舒张末期容积（EDV）、射血分数（EF）和整体应变（GLS）外，我们还基于无创压力-应变环测量了整体和局部心肌做功以及左心室效率。
在所有接受HBS治疗的患者中，优化PM设置导致心肌功能参数立即发生变化。起搏时，RVS患者的EF和GLS下降幅度高于HBS患者。仅RVS患者的左心室整体做功和左心室做功效率显著下降。
区域和整体心肌功能的变化可以通过功能超声心动图得到证实和量化。在接受PM治疗的患者中，与传统的RVS相比，HBS显示出功能优势。
