Ivanovski Maja, Mrak Miha, Mežnar Anja Zupan, Žižek David
Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia.
J Cardiovasc Dev Dis. 2022 Jul 1;9(7):209. doi: 10.3390/jcdd9070209.
Conduction system pacing (CSP) modalities, including His-bundle pacing (HBP) and left bundle branch pacing (LBBP), are increasingly used as alternatives to biventricular (BiV) pacing in heart failure (HF) patients scheduled for pace and ablate strategy. The aim of the study was to compare clinical outcomes of HF patients with refractory AF who received either BiV pacing or CSP in conjunction with atrio-ventricular node ablation (AVNA). Fifty consecutive patients (male 48%, age 70 years (IQR 9), left ventricular ejection fraction (LVEF) 39% (IQR 12)) were retrospectively analysed. Thirteen patients (26%) received BiV pacing, 27 patients (54%) HBP and 10 patients (20%) LBBP. All groups had similar baseline characteristics and acute success rate. While New York Heart. Association (NYHA) class improved in both HBP (p < 0.001) and LBBP (p = 0.008), it did not improve in BiV group (p = 0.096). At follow-up, LVEF increased in HBP (form 39% (IQR 15) to 49% (IQR 16), p < 0.001) and LBBP (from 28% (IQR 13) to 40% (IQR 13), p = 0.041), but did not change in BiV group (p = 0.916). Conduction system pacing modalities showed superior symptomatic and echocardiographic improvement compared to BiV pacing after AVNA. With more stable pacing parameters, LBBP could present a more feasible pacing option compared to HBP.
传导系统起搏（CSP）模式，包括希氏束起搏（HBP）和左束支起搏（LBBP），在计划接受起搏和消融策略的心力衰竭（HF）患者中越来越多地被用作双心室（BiV）起搏的替代方法。本研究的目的是比较接受BiV起搏或CSP联合房室结消融（AVNA）的难治性房颤HF患者的临床结局。对50例连续患者（男性占48%，年龄70岁（四分位间距9），左心室射血分数（LVEF）39%（四分位间距12））进行回顾性分析。13例患者（26%）接受BiV起搏，27例患者（54%）接受HBP，10例患者（20%）接受LBBP。所有组的基线特征和急性成功率相似。虽然纽约心脏协会（NYHA）心功能分级在HBP组（p<0.001）和LBBP组（p=0.008）均有改善，但在BiV组未改善（p=0.096）。随访时，LVEF在HBP组（从39%（四分位间距15）增至49%（四分位间距16），p<0.001）和LBBP组（从28%（四分位间距13）增至40%（四分位间距13），p=0.041）升高，但在BiV组未改变（p=0.916）。与AVNA后的BiV起搏相比，传导系统起搏模式显示出更优的症状改善和超声心动图改善。由于起搏参数更稳定，与HBP相比，LBBP可能是一种更可行的起搏选择。
