Department of Cardiology, Sichuan Provincial People's Hospital, Chengdu 610072.
Department of Cardiology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021 Apr 28;46(4):379-384. doi: 10.11817/j.issn.1672-7347.2021.200640.
To compare the left ventricular systolic function between the 1eft bundle branch pacing (LBBP) and right ventricular septum pacing (RVSP) in patients with pacemaker dependence by three-dimensional speckle tracking imaging (3D-STI).
A total of 65 patients with atrioventricular block (AVB) (Mobitz type II second-degree AVB, high-degree AVB, or third-degree AVB), who underwent permanent cardiac pacing implantation including 32 patients receiving LBBP (LBBP group) and 33 patients receiving RVSP (RVSP group) from June 2018 to June 2019,were enrolled in this study. These patients met the following inclusion criterion: pre-operative left ventricular ejection fraction (LVEF)>50% and ventricular pacing rate>40% at 6-month programming follow-up; and the patients underwent echocardiography at pre-operation and 6 months after operation. The 3D-STI was used to obtain global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS).
All the patients in the LBBP group and the RVSP group had normal LVEF, there was no significant difference between the 2 group (>0.05). The LVEF was slightly decreased at 6-month follow-up in the RVSP group, but there was no significant change compared with pre-operation (>0.05). There were no significant difference in LVEF, GLS, GCS, GRS and GAS at pre-operation and 6-month after operation between the LBBP group and the RVSP group (all >0.05). Compared with pre-operation, the GLS and GCS were significantly decreased in the LBBP group; while the GLS, GCS, GRS and GAS in the RVSP group were also significantly decreased at 6-month follow-up (all <0.05).
For patients with pacemaker dependence and normal LVEF at pre-operation, the cardiac function in the LBBP group is not significantly better than that in the RVSP group in short term follow-up. But in terms of physiologic pacing and long-term cardiac function protection, the 1eft bundle branch pacing is an optimal pacing mode.
通过三维斑点追踪成像（3D-STI）比较左束支起搏（LBBP）与右室间隔部起搏（RVSP）在依赖起搏器患者左心室收缩功能的差异。
本研究共纳入 2018 年 6 月至 2019 年 6 月期间因房室传导阻滞（AVB）（莫氏Ⅱ型 2 度 AVB、高度 AVB 或 3 度 AVB）行永久性心脏起搏植入术的 65 例患者，其中 32 例行 LBBP（LBBP 组），33 例行 RVSP（RVSP 组）。所有患者术前左心室射血分数（LVEF）>50%，且 6 个月程控随访时心室起搏比例>40%。所有患者均于术前及术后 6 个月行超声心动图检查。应用 3D-STI 获取整体纵向应变（GLS）、整体周向应变（GCS）、整体径向应变（GRS）及整体面积应变（GAS）。
LBBP 组和 RVSP 组所有患者术前 LVEF 均正常，两组间比较差异无统计学意义（>0.05）。RVSP 组术后 6 个月 LVEF 较术前略有下降，但差异无统计学意义（>0.05）。LBBP 组和 RVSP 组术前及术后 6 个月 LVEF、GLS、GCS、GRS 及 GAS 比较差异均无统计学意义（均>0.05）。与术前比较，LBBP 组 GLS、GCS 明显下降，RVSP 组术后 6 个月 GLS、GCS、GRS 及 GAS 亦明显下降（均<0.05）。
对于术前 LVEF 正常且依赖起搏器的患者，短期随访中 LBBP 组患者心功能并不优于 RVSP 组，但从生理性起搏及长期心功能保护角度考虑，左束支起搏是一种较为理想的起搏模式。
