Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
Europace. 2020 Dec 26;22(Suppl_2):ii45-ii53. doi: 10.1093/europace/euaa295.
His-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre.
Permanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacing parameters, 12-lead ECG, echocardiography, and clinical outcomes were evaluated during follow-up. A total of 64 patients with HB pacing and 185 with LBB pacing were included. Left bundle branch pacing exhibited a slightly longer paced QRS duration than HB pacing (117.7 ± 11.0 vs. 113.7 ± 19.8 ms, P = 0.04). Immediate post-operation, LBB pacing had a significant higher R-wave amplitude (16.5 ± 7.5 vs. 4.3 ± 3.6 mV, P < 0.001) and lower capture threshold (0.5 ± 0.1 vs. 1.2 ± 0.8 V, P < 0.001) compared with HB pacing. During follow-up, an increase in capture threshold of >1.0 V from baseline was found in eight (12.5%) patients in the HB pacing group and none in LBB pacing. Paced QRS morphology changed from Qr to QS in lead V1 in seven patients (3.8%) with LBB pacing. Both HB and LBB pacing preserved cardiac function in patients with left ventricular ejection fraction (LVEF) over 50%. In patients with LVEF <50%, both HB and LBB pacing improved clinical outcomes during follow-up.
His-Purkinje system pacing produced favourable electrical synchrony and improved cardiac function in patients with heart failure. Left bundle branch pacing showed superior pacing parameters over HB pacing. Lead micro-displacement with changes in paced QRS morphology posts a concern in LBB pacing.
希氏束（HPS）起搏，包括希氏束（HB）起搏和左束支（LBB）起搏，近年来已成为研究热点。HB 起搏和 LBB 起搏的导线性能和临床结果比较鲜有报道。本研究旨在探讨本中心永久性 HPS 起搏患者的中远期导线性能和临床结果。
HB 起搏通过将起搏导线置于 HB 区域实现。LBB 起搏通过将导线置于室间隔左侧心内膜下实现。随访时评估起搏参数、12 导联心电图、超声心动图和临床结果。共纳入 64 例 HB 起搏患者和 185 例 LBB 起搏患者。LBB 起搏的起搏 QRS 时限略长于 HB 起搏（117.7±11.0 比 113.7±19.8 毫秒，P=0.04）。术后即刻，LBB 起搏的 R 波振幅显著高于 HB 起搏（16.5±7.5 比 4.3±3.6 毫伏，P<0.001），而捕获阈值较低（0.5±0.1 比 1.2±0.8 毫伏，P<0.001）。随访期间，HB 起搏组有 8 例（12.5%）患者的捕获阈值较基线增加>1.0 毫伏，而 LBB 起搏组无此现象。LBB 起搏中有 7 例（3.8%）患者 V1 导联的起搏 QRS 形态由 Qr 变为 QS。HB 和 LBB 起搏均能保持左心室射血分数（LVEF）>50%患者的心脏功能。LVEF<50%的患者，HB 和 LBB 起搏均能改善随访期间的临床结果。
希氏束系统起搏产生良好的电同步性，改善心力衰竭患者的心脏功能。LBB 起搏的起搏参数优于 HB 起搏。LBB 起搏导线微移位伴起搏 QRS 形态改变引起关注。
