Wang Ning, Zhu Tianyu, Li Yan, Cheng Guanliang, Chen Yu, Fu Yuwei, Chen Xuezhi, Liu Xiaohui
Department of Cardiology, Peking University International Hospital, Beijing, China.
Department of Ultrasound, Peking University International Hospital, Beijing, China.
Front Cardiovasc Med. 2023 Mar 7;10:1049482. doi: 10.3389/fcvm.2023.1049482. eCollection 2023.
BACKGROUND & OBJECTIVE: Tricuspid regurgitation after left-sided valve surgery was a common and difficult problem. Atrial fibrillation was considered to be an important etiology of tricuspid regurgitation. His-Purkinje system pacing (HPSP) was a physiological pacing method, which could prevent and treat heart failure and might reduce tricuspid regurgitation. Our study aimed to investigate the effect of HPSP on tricuspid regurgitation in patients with persistent atrial fibrillation after left-sided valve surgery.
This study was a retrospective study. The 3-year patient review focused on those who underwent permanent cardiac pacemaker implantation of HPSP after mitral valve and/or aortic valve replacement from Jan 1st, 2019 to Jan 1st, 2022. HPSP included His bundle pacing (HBP) or left bundle branch pacing (LBBP). Clinical data collected included electrocardiogram, pacing parameters, ultrasonic cardiogram parameters and chest x-ray at implantation and 3-month follow up. Univariate and multivariate linear regression analysis of tricuspid regurgitation velocity were performed.
A total of 44 patients was retrospectively reviewed. Eight patients who had undergone implantation of HPSP after left-sided heart valve replacement were enrolled in the study. All patients had persistent atrial fibrillation. Three of them received HBP and five underwent LBBP. At 3-month follow-up, the tricuspid regurgitation grade was significantly lower than that before implantation (= 0.007). The tricuspid regurgitation velocity significantly decreased (317 ± 74 cm/s vs. 261 ± 52 cm/s, ) and tricuspid valve pressure gradient (PG) reduced (42 ± 21 mmHg vs. 28 ± 10 mmHg, ). The cardiothoracic ratio of patients was significantly lower than that before implantation (0.61 ± 0.08 vs. 0.64 ± 0.09, ). The NYHA classification of patients also improved (= 0.013). In multivariate liner regression analysis, the pacing ratio (= 0.736, ) was an independent determinant of tricuspid regurgitation velocity variation.
HPSP might reduce tricuspid regurgitation and improve cardiac function in patients with persistent atrial fibrillation after left-sided valve surgery.
左侧瓣膜手术后三尖瓣反流是一个常见且棘手的问题。心房颤动被认为是三尖瓣反流的重要病因。希氏 - 浦肯野系统起搏（HPSP）是一种生理性起搏方法，可预防和治疗心力衰竭，可能会减轻三尖瓣反流。本研究旨在探讨HPSP对左侧瓣膜手术后持续性心房颤动患者三尖瓣反流的影响。
本研究为回顾性研究。对2019年1月1日至2022年1月1日期间接受二尖瓣和/或主动脉瓣置换术后进行HPSP永久性心脏起搏器植入的患者进行了为期3年的回顾。HPSP包括希氏束起搏（HBP）或左束支起搏（LBBP）。收集的临床资料包括植入时及3个月随访时的心电图、起搏参数、超声心动图参数和胸部X线。对三尖瓣反流速度进行单因素和多因素线性回归分析。
共回顾性分析了44例患者。纳入8例左侧心脏瓣膜置换术后接受HPSP植入的患者。所有患者均为持续性心房颤动。其中3例接受HBP，5例接受LBBP。在3个月随访时，三尖瓣反流分级显著低于植入前（=0.007）。三尖瓣反流速度显著降低（317±74cm/s对261±52cm/s，），三尖瓣跨瓣压差（PG）降低（42±21mmHg对28±10mmHg，）。患者的心胸比显著低于植入前（0.61±0.08对0.64±0.09，）。患者的纽约心脏协会（NYHA）分级也有所改善（=0.013）。在多因素线性回归分析中，起搏比例（=0.736，）是三尖瓣反流速度变化的独立决定因素。
HPSP可能会减轻左侧瓣膜手术后持续性心房颤动患者的三尖瓣反流并改善心功能。
