比较心脏再同步治疗的方法：左束支区域、希氏束和双心室起搏的急性电生理和血液动力学的患者内比较。

Comparison of methods for delivering cardiac resynchronization therapy: an acute electrical and haemodynamic within-patient comparison of left bundle branch area, His bundle, and biventricular pacing.

机构信息

Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Du Cane Road, London W120HS, UK.

Medtronic Limited, Building 9, Croxley Green Business Park, Watford WD18 8WW, UK.

出版信息

Europace. 2023 Mar 30;25(3):1060-1067. doi: 10.1093/europace/euac245.

AIMS

Left bundle branch area pacing (LBBAP) is a promising method for delivering cardiac resynchronization therapy (CRT), but its relative physiological effectiveness compared with His bundle pacing (HBP) is unknown. We conducted a within-patient comparison of HBP, LBBAP, and biventricular pacing (BVP).

METHODS AND RESULTS

Patients referred for CRT were recruited. We assessed electrical response using non-invasive mapping, and acute haemodynamic response using a high-precision haemodynamic protocol. Nineteen patients were recruited: 14 male, mean LVEF of 30%. Twelve had time for BVP measurements. All three modalities reduced total ventricular activation time (TVAT), (ΔTVATHBP -43 ± 14 ms and ΔTVATLBBAP -35 ± 20 ms vs. ΔTVATBVP -19 ± 30 ms, P = 0.03 and P = 0.1, respectively). HBP produced a significantly greater reduction in TVAT compared with LBBAP in all 19 patients (-46 ± 15 ms, -36 ± 17 ms, P = 0.03). His bundle pacing and LBBAP reduced left ventricular activation time (LVAT) more than BVP (ΔLVATHBP -43 ± 16 ms, P < 0.01 vs. BVP, ΔLVATLBBAP -45 ± 17 ms, P < 0.01 vs. BVP, ΔLVATBVP -13 ± 36 ms), with no difference between HBP and LBBAP (P = 0.65). Acute systolic blood pressure was increased by all three modalities. In the 12 with BVP, greater improvement was seen with HBP and LBBAP (6.4 ± 3.8 mmHg BVP, 8.1 ± 3.8 mmHg HBP, P = 0.02 vs. BVP and 8.4 ± 8.2 mmHg for LBBAP, P = 0.3 vs. BVP), with no difference between HBP and LBBAP (P = 0.8).

CONCLUSION

HBP delivered better ventricular resynchronization than LBBAP because right ventricular activation was slower during LBBAP. But LBBAP was not inferior to HBP with respect to LV electrical resynchronization and acute haemodynamic response.

目的

左束支区域起搏（LBBAP）是一种有前途的心脏再同步治疗（CRT）方法，但与希氏束起搏（HBP）相比，其相对生理效果尚不清楚。我们对 HBP、LBBAP 和双心室起搏（BVP）进行了患者内比较。

方法和结果

招募了因 CRT 而就诊的患者。我们使用非侵入性映射评估电反应，使用高精度血液动力学方案评估急性血液动力学反应。共招募了 19 名患者：14 名男性，平均 LVEF 为 30%。12 名患者有时间进行 BVP 测量。所有三种方式均缩短了总心室激活时间（TVAT），（ΔTVATHBP -43 ± 14 ms 和 ΔTVATLBBAP -35 ± 20 ms 与 ΔTVATBVP -19 ± 30 ms 相比，P = 0.03 和 P = 0.1）。在所有 19 名患者中，HBP 与 LBBAP 相比，TVAT 的减少更为显著（-46 ± 15 ms，-36 ± 17 ms，P = 0.03）。HBP 和 LBBAP 比 BVP 更能缩短左心室激活时间（LVAT）（ΔLVATHBP -43 ± 16 ms，P < 0.01 与 BVP，ΔLVATLBBAP -45 ± 17 ms，P < 0.01 与 BVP，ΔLVATBVP -13 ± 36 ms），HBP 与 LBBAP 之间无差异（P = 0.65）。急性收缩压在所有三种方式下均升高。在 12 名进行 BVP 的患者中，HBP 和 LBBAP 有更大的改善（BVP 为 6.4 ± 3.8 mmHg，HBP 为 8.1 ± 3.8 mmHg，P = 0.02 与 BVP 相比，LBBAP 为 8.4 ± 8.2 mmHg，P = 0.3 与 BVP 相比），HBP 和 LBBAP 之间无差异（P = 0.8）。