希氏束起搏对永久性心脏起搏器植入患者右心室功能的影响。
Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation.
机构信息
Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy.
Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
出版信息
Pacing Clin Electrophysiol. 2021 Jun;44(6):986-994. doi: 10.1111/pace.14249. Epub 2021 May 7.
BACKGROUND
His-Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown.
METHODS
We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram.
RESULTS
A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV-FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31-37) vs. RVP 33 IQR (29.7-37.2),p = .602; 6-months: HBP 37 IQR (33-39) vs. RVP 30 IQR (27.7-35), p < .0001] and RV-GLS (Global Longitudinal Strain)% [baseline: HBP -18 IQR (-20.2 to -15) vs. RVP -16 IQR (-18.7 to -14), p = .150; 6-months: HBP -20 IQR(-23 to -17) vs. RVP -13.5 IQR (-16 to -11), p < .0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) (p < .0001) and S wave velocity (p < .0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32-42) mmHg vs. RVP 34 IQR (31.5-37) mmHg,p = .060; 6-months: HBP 32 IQR (26-38) mmHg vs. RVP 39 IQR (36-41) mmHg, p < .0001] and tricuspid regurgitation (p = .005) irrespectively from lead position above or below the tricuspid valve.
CONCLUSIONS
In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.
背景
希氏束起搏（HBP）是一种新兴的生理起搏技术。然而，其对右心室（RV）性能的影响尚不清楚。
方法
我们连续招募了需要植入起搏器（PM）的患者，以比较 HBP 与 RV 起搏（RVP）对 RV 性能的影响。患者在植入前和 6 个月后通过经胸超声心动图进行评估。
结果
共纳入 84 例患者（年龄 75.1±7.9 岁，64%为男性），42 例（50%）成功进行了 HBP，42 例（50%）行心尖 RVP。随访时，我们发现 RV-FAC（分数面积变化）%有显著改善[基线：HBP 34 IQR（31-37）与 RVP 33 IQR（29.7-37.2），p=0.602；6 个月：HBP 37 IQR（33-39）与 RVP 30 IQR（27.7-35），p<0.0001]和 RV-GLS（整体纵向应变）%[基线：HBP -18 IQR（-20.2 至-15）与 RVP -16 IQR（-18.7 至-14），p=0.150；6 个月：HBP -20 IQR（-23 至-17）与 RVP -13.5 IQR（-16 至-11），p<0.0001]，而 RVP 与这两个参数的显著下降相关。RVP 还与三尖瓣环平面收缩期位移（TAPSE）（p<0.0001）和 S 波速度（p<0.0001）的随访时显著恶化相关。相反，与 RVP 相比，HBP 显著改善肺动脉收缩压（PASP）[基线：HBP 38 IQR（32-42）mmHg 与 RVP 34 IQR（31.5-37）mmHg，p=0.060；6 个月：HBP 32 IQR（26-38）mmHg 与 RVP 39 IQR（36-41）mmHg，p<0.0001]和三尖瓣反流（p=0.005），无论起搏导线位于三尖瓣上方还是下方。
结论
在接受 PM 植入的患者中，与 RVP 相比，HBP 对 RV 功能产生有益和保护作用。
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