Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital/The Affiliated Hospital of Southwest Jiaotong University, No.82, Qinglong Street, Qingyang District, Chengdu, 610031, Sichuan Province, China.
BMC Cardiovasc Disord. 2022 Aug 21;22(1):380. doi: 10.1186/s12872-022-02818-z.
To evaluate ventricular synchronization and function in patients with right bundle-branch block after left bundle-branch-area pacing (LBBAP) by echocardiography.
Forty patients who successfully received LBBAP were selected and divided into the right bundle-branch block group (RBBB group) and the non-RBBB group by pre-operation ECG. Echocardiography and follow-up were performed 1 month after operation. Interventricular synchronization was evaluated by tissue Doppler (TDI), tissue mitral annular displacement (TMAD), and interventricular mechanical delay. The tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tricuspid annulus sidewall systolic velocity (TV-s'), left ventricular global ventricular longitudinal strain (GLS), right ventricular free wall longitudinal strain (LS-RV), standard deviation of left ventricular 18 segments peak time difference (SDt-L) and standard deviation of right ventricular free wall 3 segments peak time difference (SDt-R) were applied to evaluate intraventricular synchronization and ventricular function.
The difference of displacement peak time of the tricuspid and mitral valves, namely ΔPT measured by TMAD, the difference of systolic time to peak of the tricuspid and mitral valves, namely ΔTs measured by TDI, were statistically different between the two groups (P < 0.05). Compared with the non-RBBB group, there were no statistically significant differences in the GLS, RVFAC, LS-RV, TAPSE, TV-s', SDt-L, SDt-R (P > 0.05).
Echocardiography technology including two-dimensional speckle tracking imaging (2D-STI), TDI, and TMAD can effectively analyze interventricular synchronization, intraventricular synchronization, and ventricular function. Although the movement of the right ventricular myocardium in the RBBB group was slightly later than that of the left ventricular myocardium after LBBAP, LBBAP could still be applied in RBBB patients with pacing indication.
通过超声心动图评估左束支区域起搏（LBBAP）后右束支传导阻滞患者的心室同步性和功能。
选择 40 例成功接受 LBBAP 的患者，根据术前心电图分为右束支阻滞组（RBBB 组）和非 RBBB 组。术后 1 个月进行超声心动图和随访。组织多普勒（TDI）、组织二尖瓣环位移（TMAD）和室间机械延迟评估室间同步性。三尖瓣环平面收缩期位移（TAPSE）、右心室射血分数（RVFAC）、三尖瓣环侧壁收缩速度（TV-s'）、左心室整体心室纵向应变（GLS）、右心室游离壁纵向应变（LS-RV）、左心室 18 节段峰值时间差标准差（SDt-L）和右心室游离壁 3 节段峰值时间差标准差（SDt-R）用于评估室内同步性和心室功能。
TMAD 测量的三尖瓣和二尖瓣瓣尖位移峰时间差（ΔPT）和 TDI 测量的三尖瓣和二尖瓣瓣尖收缩时间峰值差（ΔTs）在两组间差异有统计学意义（P < 0.05）。与非 RBBB 组相比，GLS、RVFAC、LS-RV、TAPSE、TV-s'、SDt-L、SDt-R 差异均无统计学意义（P > 0.05）。
二维斑点追踪成像（2D-STI）、TDI 和 TMAD 等超声心动图技术可有效分析室间同步性、室内同步性和心室功能。虽然 RBBB 组 LBBAP 后右心室心肌运动略迟于左心室，但仍可应用于有起搏适应证的 RBBB 患者。
