左束支起搏与右心室起搏的中期随访后可行性和安全性：单中心经验。
The feasibility and safety of left bundle branch pacing vs. right ventricular pacing after mid-long-term follow-up: a single-centre experience.
机构信息
Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
出版信息
Europace. 2020 Dec 26;22(Suppl_2):ii36-ii44. doi: 10.1093/europace/euaa294.
AIMS
The aim of this study is to prospectively assess the feasibility and safety of left bundle branch pacing (LBBP) when compared with right ventricular pacing (RVP) during mid-long-term follow-up in a large cohort.
METHODS AND RESULTS
Patients (n = 554) indicated for pacemaker implantation were prospectively and consecutively enrolled and were non-randomized divided into LBBP group and RVP group. The levels of cTnT and N-terminal pro-B type natriuretic peptide were measured and compared within 2 days post-procedure between two groups. Implant characteristics, procedure-related complications, and clinical outcomes were also compared. Pacing thresholds, sensing, and impedance were assessed during procedure and follow-up. Left bundle branch pacing was feasible with a success rate of 94.8% with high incidence of LBB potential (89.9%), selective LBBP (57.8%), and left deviation of paced QRS axis (79.7%) with mean Sti-LVAT of 65.07 ± 8.58 ms. Paced QRS duration was significantly narrower in LBBP when compared with RVP (132.02 ± 7.93 vs. 177.68 ± 15.58 ms, P < 0.0001) and the pacing parameters remained stable in two groups during 18 months follow-up. cTnT elevation was more significant in LBBP when compared with RVP within 2 days post-procedure (baseline: 0.03 ± 0.03 vs. 0.02 ± 0.03 ng/mL, P = 0.002; 1 day post-procedure: 0.13 ± 0.09 vs. 0.04 ± 0.03 ng/mL, P < 0.001; 2 days post-procedure: 0.10 ± 0.08 vs. 0.03 ± 0.08 ng/mL, P < 0.001). The complications and cardiac outcomes were not significantly different between two groups.
CONCLUSION
Left bundle branch pacing was feasible in bradycardia patients associated with stable pacing parameters during 18 months follow-up. Paced QRS duration was significantly narrower than that of RVP. Though cTnT elevation was more significant in LBBP within 2 days post-procedure, the complications, and cardiac outcomes were not significantly different between two groups.
目的
本研究旨在前瞻性评估左束支起搏（LBBP）与右心室起搏（RVP）在中-长期随访期间的可行性和安全性。
方法和结果
前瞻性连续招募了 554 名需要植入起搏器的患者，并将其非随机分为 LBBP 组和 RVP 组。比较两组术后 2 天内 cTnT 和 N 端脑钠肽前体（NT-proBNP）水平。比较植入特征、与手术相关的并发症和临床结果。术中及随访时评估起搏阈值、感知和阻抗。左束支起搏成功率为 94.8%，左束支电位（LBBP）发生率高（89.9%）、选择性 LBBP（57.8%）和起搏 QRS 轴左偏（79.7%），平均 Sti-LVAT 为 65.07±8.58ms。与 RVP 相比，LBBP 时起搏 QRS 时限明显变窄（132.02±7.93 比 177.68±15.58ms，P<0.0001），两组在 18 个月随访期间起搏参数稳定。与 RVP 相比，LBBP 术后 2 天内 cTnT 升高更显著（基线：0.03±0.03 比 0.02±0.03ng/ml，P=0.002；1 天：0.13±0.09 比 0.04±0.03ng/ml，P<0.001；2 天：0.10±0.08 比 0.03±0.08ng/ml，P<0.001）。两组并发症和心脏结局无显著差异。
结论
在 18 个月的随访期间，左束支起搏在心动过缓患者中是可行的，起搏参数稳定。起搏 QRS 时限明显窄于 RVP。虽然 LBBP 术后 2 天内 cTnT 升高更显著，但两组并发症和心脏结局无显著差异。
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