Hua Wei, Liu Xi, Gu Min, Niu Hong-Xia, Chen Xuhua, Tang Min, Zhang Shu
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2021 Sep 3;8:712051. doi: 10.3389/fcvm.2021.712051. eCollection 2021.
His bundle pacing (HBP) is the most widely used physiological pacing modality, but difficulties in locating the His bundle lead to high fluoroscopic exposure. An electroanatomical mapping (EAM) system can be an efficient tool to achieve HBP implantation with near-zero fluoroscopic visualization. In the study, 20 patients who had indications for pacemaker implantation were prospectively enrolled and underwent HBP implantation either with the conventional fluoroscopy approach (the standard group) or guided by a novel KODEX-EPD mapping system (the EAM-guided group). The success rate, procedural details, pacing parameters, and procedure-related complications were compared between the two groups. In the study, 20 consecutive patients were randomized with 10 patients in each group. HBP was successfully achieved in nine patients in the standard group and nine patients in the EAM-guided group. The procedural time was similar between the EAM-guided group vs. the standard group (85.40 ± 22.34 vs. 86.50 ± 15.05 min, = 0.90). In comparison with the standard group, the EAM-guided group had a significant shorter total fluoroscopic time (FT) (1.45 ± 0.58 vs. 12.36 ± 5.46 min, < 0.01) and His lead fluoroscopic time (HL-FT) (0.84 ± 0.56 vs. 9.27 ± 5.44 min, < 0.01), while lower total fluoroscopic dose (3.13 ± 1.24 vs. 25.38 ± 11.15 mGy, < 0.01) and His lead fluoroscopic dose (1.85 ± 1.17 vs. 19.06 ± 11.03 mGy, < 0.01). No significant differences were observed in paced QRS duration and pacing parameters between the two groups. During a 3-month follow-up, one patient had a capture threshold increased >1 V/1.0 ms in the standard group, while no other complications were recorded in either group. The KODEX-EPD system could facilitate HBP implantation with significantly reduced FT and dose without compromising the procedural time.
希氏束起搏（HBP）是应用最广泛的生理性起搏方式，但希氏束定位困难导致X线透视暴露时间长。电解剖标测（EAM）系统可能是一种实现近乎零X线透视可视化的希氏束起搏植入的有效工具。在本研究中，前瞻性纳入20例有起搏器植入指征的患者，分别采用传统X线透视方法（标准组）或新型KODEX-EPD标测系统引导（EAM引导组）进行希氏束起搏植入。比较两组的成功率、手术细节、起搏参数及手术相关并发症。本研究中，连续20例患者随机分组，每组10例。标准组9例患者和EAM引导组9例患者成功实现希氏束起搏。EAM引导组与标准组的手术时间相似（85.40±22.34 vs. 86.50±15.05分钟，P = 0.90）。与标准组相比，EAM引导组的总透视时间（FT）显著缩短（1.45±0.58 vs. 12.36±5.46分钟，P<0.01），希氏束电极透视时间（HL-FT）也显著缩短（0.84±0.56 vs. 9.27±5.44分钟，P<0.01），同时总透视剂量（3.13±1.24 vs. 25.38±11.15 mGy, P<0.01）和希氏束电极透视剂量（1.85±1.17 vs. 19.06±11.03 mGy, P<0.01）更低。两组之间的起搏QRS时限和起搏参数无显著差异。在3个月的随访期间，标准组有1例患者的夺获阈值升高>1 V/1.0 ms，而两组均未记录到其他并发症。KODEX-EPD系统可促进希氏束起搏植入，显著缩短透视时间和剂量，且不影响手术时间。
