Wei Hui-Qiang, Li Hui, Liao Hongtao, Liang Yuanhong, Zhan Xianzhang, Zhang Qianhuan, Deng Hai, Wei Wei, Liao Zili, Liu Yang, Liu Fangzhou, Lin Weidong, Xue Yumei, Wu Shulin, Fang Xianhong
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2021 Aug 17;8:705124. doi: 10.3389/fcvm.2021.705124. eCollection 2021.
The feasibility and safety of left bundle branch pacing (LBBP) in patients with conduction diseases following prosthetic valves (PVs) have not been well described. Permanent LBBP was attempted in patients with PVs. Procedural success and intracardiac electrical measurements were recorded at implant. Pacing threshold, complications, and echocardiographic data were assessed at implant and follow-up visit. Twenty-two consecutive patients with atrioventricular (AV) conduction disturbances (10 with AV nodal block and 12 with infranodal block) underwent LBBP. The PVs included aortic valve replacement (AVR) in six patients, mitral valve repair or replacement (MVR) with tricuspid valve ring (TVR) in four patients, AVR with TVR in one patient, AVR with MVR plus TVR in three patients, transcatheter aortic valve replacement (TAVR) in five patients, and MVR alone in three patients. LBBP succeeded in 20 of 22 (90.9%) patients. LBB potential was observed in 15 of 22 (68.2%) patients, including 10 of 15 (66.7%) patients with AVR/TAVR and five of seven (71.4%) patients without AVR/TAVR. AVR and TVR served as good anatomic landmarks for facilitating the LBBP. The final sites of LBBP were 17.9 ± 1.4 mm inferior to the AVR and 23.0 ± 3.2 mm distal and septal to the TVR. The paced QRS duration was 124.5 ± 13.8 ms, while the baseline QRS duration was 120.0 ± 32.5 ms ( = 0.346). Pacing threshold and R-wave amplitude at implant were 0.60 ± 0.16 V at 0.5 ms and 11.9 ± 5.5 mV and remained stable at the mean follow-up of 16.1 ± 10.8 months. No significant exacerbation of tricuspid valve regurgitation was observed compared to baseline. Permanent LBBP could be feasibly and safely obtained in the majority of patients with PVs. The location of the PV might serve as a landmark for guiding the final site of the LBBP. Stable pacing parameters were observed during the follow-up.
人工瓣膜（PV）置换术后传导疾病患者行左束支起搏（LBBP）的可行性和安全性尚未得到充分描述。对PV置换术后患者尝试进行永久性LBBP。记录植入时的手术成功率和心内电测量值。在植入时和随访时评估起搏阈值、并发症及超声心动图数据。22例连续的房室（AV）传导障碍患者（10例房室结阻滞，12例结下阻滞）接受了LBBP。PV包括6例主动脉瓣置换术（AVR）、4例二尖瓣修复或置换术（MVR）联合三尖瓣环成形术（TVR）、1例AVR联合TVR、3例AVR联合MVR加TVR、5例经导管主动脉瓣置换术（TAVR）以及3例单纯MVR。22例患者中有20例（90.9%）LBBP成功。22例患者中有15例（68.2%）观察到左束支电位，包括15例中有10例（66.7%）行AVR/TAVR的患者和7例中有5例（71.4%）未行AVR/TAVR的患者。AVR和TVR可作为有助于LBBP的良好解剖标志。LBBP的最终位点在AVR下方17.9±1.4mm处，在TVR远端和间隔23.0±3.2mm处。起搏QRS波时限为124.5±13.8ms，而基线QRS波时限为120.0±32.5ms（P = 0.346）。植入时起搏阈值和R波振幅在脉宽0.5ms时为0.60±0.16V，R波振幅为11.9±5.5mV，在平均16.1±10.8个月的随访中保持稳定。与基线相比，未观察到三尖瓣反流明显加重。大多数PV置换术后患者可行且安全地获得永久性LBBP。PV的位置可作为指导LBBP最终位点的标志。随访期间观察到稳定的起搏参数。
