心力衰竭患者采用左束支起搏的心脏再同步治疗
Cardiac resynchronization therapy in heart failure patients by using left bundle branch pacing.
作者信息
Gu Ying, Li Yanming, Zhu Ying, Lin Xiuyu, Tian Tian, Zhang Qigao, Gong Jianbin, Wang Lei, Li Jianhua
机构信息
Department of Cardiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Department of Ultrasonic Diagnosis, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
出版信息
Front Cardiovasc Med. 2022 Aug 23;9:990016. doi: 10.3389/fcvm.2022.990016. eCollection 2022.
BACKGROUND
Left bundle branch pacing (LBBP) is emerging as an effective alternative to achieve cardiac resynchronization therapy (CRT) and improve heart function. The purpose of our study was to investigate the feasibility and efficacy of LBBP in heart failure patients with left ventricular ejection fraction (LVEF) <50% and left bundle branch block (LBBB).
METHODS
All patients with complete LBBB and LVEF <50% were retrospectively included in the study from April 2018 to April 2021 and underwent CRT LBBP implantation. ECG, pacing parameters, the New York Heart Association (NYHA) functional class, echocardiographic measurements, and complications were recorded and analyzed at implant and during follow-up of 1, 6, and 12 months.
RESULTS
Left bundle branch pacing was successful in all 34 patients (mean age 65.6 ± 11.2 years, 67.6% men). A significant decrease in QRS duration (QRSd) was observed after the LBBP operation for 1 month (153.2 ± 1.7 vs. 111.9 ± 2.6 ms, < 0.01). LBB capture threshold and R-wave amplitude remained stable at 12-month follow-up when compared with implantation values (0.62 ± 0.13 V @ 0.4 ms vs. 0.73 ± 0.21 V @ 0.4 ms, 12.02 ± 5.68 mV vs. 8.58 ± 4.09 mV, respectively). LVEF increased significantly (35.28 ± 1.70% vs. 51.09 ± 1.71%, < 0.01) accompanied with reduced left ventricular end-diastolic dimension (LVEDd; 65.3 ± 1.99 vs. 53.58 ± 2.07 mm, < 0.01) and left atrial dimension (LAD; 49.03 ± 1.32 vs. 40.67 ± 1.58 mm, < 0.01). Normalized LVEF (LVEF ≥ 50%) was found in 70.5% of patients at 12 months. The NYHA classification, brain natriuretic peptide (BNP), and 6-minute walk test (6MWT) were significantly improved at follow-up of 12 months (all < 0.01 vs. baseline). No deaths or heart failure hospitalizations were observed during the follow-up period.
CONCLUSION
The current work suggested that LBBP was feasible with a high success implantation rate and effective to correct LBBB and improved left ventricular structure and function with a low and stable pacing threshold.
背景
左束支起搏（LBBP）正在成为实现心脏再同步治疗（CRT）并改善心脏功能的一种有效替代方法。我们研究的目的是探讨LBBP在左心室射血分数（LVEF）<50%且存在左束支传导阻滞（LBBB）的心力衰竭患者中的可行性和疗效。
方法
回顾性纳入2018年4月至2021年4月所有患有完全性LBBB且LVEF<50%的患者，并进行CRT-LBBP植入。在植入时以及1、6和12个月的随访期间记录并分析心电图、起搏参数、纽约心脏协会（NYHA）功能分级、超声心动图测量结果及并发症。
结果
34例患者（平均年龄65.6±11.2岁，男性占67.6%）的左束支起搏均成功。LBBP术后1个月观察到QRS波时限（QRSd）显著缩短（153.2±1.7 vs. 111.9±2.6毫秒，<0.01）。与植入时的值相比，12个月随访时LBB起搏阈值和R波振幅保持稳定（分别为0.62±0.13V@0.4毫秒 vs. 0.73±0.21V@0.4毫秒，12.02±5.68毫伏 vs. 8.58±4.09毫伏）。LVEF显著增加（35.28±1.70% vs. 51.09±1.71%，<0.01），同时左心室舒张末期内径（LVEDd）减小（65.3±1.99 vs. 53.58±2.07毫米，<0.01），左心房内径（LAD）减小（49.03±1.32 vs. 40.67±1.58毫米，<0.01）。12个月时70.5%的患者LVEF恢复正常（LVEF≥50%）。在12个月的随访中，NYHA分级、脑钠肽（BNP）和6分钟步行试验（6MWT）均有显著改善（与基线相比均<0.01）。随访期间未观察到死亡或因心力衰竭住院的情况。
结论
目前的研究表明，LBBP是可行的，植入成功率高，能有效纠正LBBB，并改善左心室结构和功能，起搏阈值低且稳定。
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