Byeon Kyeongmin, Kim Hye Ree, Park Seung-Jung, Park Young Jun, Choi Ji-Hoon, Kim Ju Youn, Park Kyoung-Min, On Young Keun, Kim June Soo
Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong 14353, Korea.
Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52727, Korea.
J Clin Med. 2022 Apr 28;11(9):2483. doi: 10.3390/jcm11092483.
Until recently, left bundle branch area pacing (LBBAp) has mostly been performed using lumen-less fixed screw leads. There are limited data on LBBAp with conventional style-driven extendable screw-in (SDES) leads, particularly data performed by operators with no previous experience with LBBAp procedures. In total, 42 consecutive patients undergoing LBBAp using SDES leads and newly designed delivery sheaths (LBBAp group) were compared with those treated with conventional right ventricular pacing (RVp) for atrioventricular block (RVp group, n = 84) using propensity score matching (1:2 ratio). The LBBAp was successful in 83% (35/42) of patients, with satisfactory pacing thresholds (0.8 ± 0.2 V at 0.4 ms). In the LBBAp group, the mean paced-QRS duration obtained during RV apical pacing (173 ± 18 ms) was significantly reduced by LBBAp (116 ± 14 ms, p < 0.001). Compared with the RVp group, the LBBAp group showed more physiological pacing, suggested by a much narrower paced-QRS duration (116 ± 14 vs. 151 ± 21 ms, p < 0.001). The pacing threshold was comparable in both groups. The LBBAp group revealed stable pacing thresholds for 6.8 ± 4.8 months post-implant and no serious complications including lead dislodgement or septal perforation. The novel approach of LBBAp using SDES leads and the new dedicated pre-shaped delivery sheaths was effectively and safely performed, even by inexperienced operators with LBBAp procedures.
直到最近，左束支区域起搏（LBBAp）大多使用无腔固定螺旋电极导线来进行。关于使用传统样式驱动的可伸展旋入式（SDES）电极导线进行LBBAp的数据有限，尤其是由之前没有LBBAp手术经验的操作者进行的相关数据。总共42例连续使用SDES电极导线和新设计的输送鞘管进行LBBAp的患者（LBBAp组），与84例因房室传导阻滞接受传统右心室起搏（RVp）治疗的患者（RVp组）采用倾向评分匹配（1:2比例）进行比较。LBBAp在83%（35/42）的患者中成功，起搏阈值令人满意（在0.4毫秒时为0.8±0.2伏）。在LBBAp组中，可以观察到，右心室心尖部起搏时获得的平均起搏QRS时限（173±18毫秒）在进行LBBAp后显著缩短（116±14毫秒，p<0.001）。与RVp组相比，LBBAp组表现出更多生理性起搏，这表现为起搏QRS时限更窄（116±14对151±21毫秒，p<0.001）。两组的起搏阈值相当。LBBAp组在植入后6.8±4.8个月显示起搏阈值稳定，且未出现包括导线脱位或室间隔穿孔在内的严重并发症。即使是没有LBBAp手术经验的操作者，使用SDES电极导线和新型专用预塑形输送鞘管进行LBBAp的新方法也能有效且安全地实施。
