预测长期持续性心房颤动患者在传导系统起搏升级后起搏诱导性心肌病的检出和结局表现。
Predictors of pacing-induced cardiomyopathy detection and outcomes demonstration after conduction system pacing upgrade on patients with long-term persistent atrial fibrillation.
机构信息
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
出版信息
Pacing Clin Electrophysiol. 2023 Jul;46(7):684-692. doi: 10.1111/pace.14752. Epub 2023 Jun 21.
OBJECTIVE
To identify the predictors of pacing-induced cardiomyopathy (PICM) and illustrate the safety and feasibility of conduction system pacing (CSP) upgrade on patients with long-term persistent atrial fibrillation (AF).
METHODS
All patients with long-term persistent AF and normal left ventricular ejection fraction (LVEF) ≥50% were consecutively enrolled from January 2008 to December 2017, and all the patients with atrioventricular block (AVB) and high right ventricular pacing (RVP) percentage of at least 40%. The predictors of PICM were identified, and patients with PICM were followed up for at least 1 year regardless of CSP upgrade. Cardiac performances and lead outcomes were investigated in all patients before and after CSP upgrade.
RESULTS
The present study included 139 patients, out of which 37 (26.62%) developed PICM, resulting in a significant decrease in the left ventricular ejection fraction (LVEF) from 56.11 ± 2.56% to 38.10 ± 5.81% (p< .01). The median duration for the development of PICM was 5.43 years. Lower LVEF (≤52.50%), longer paced QRS duration (≥175 ms), and higher RVP percentage (≥96.80%) were identified as independent predictors of PICM. Furthermore, the morbidity of PICM progressively increased with an increased number of predictors. The paced QRS duration (183.90 ± 22.34 ms vs. 136.57 ± 20.71 ms, p < .01), LVEF (39.35 ± 2.71% vs. 47.50 ± 7.43%, p < .01), and left ventricular end-diastolic diameter (LVEDD) (55.53 ± 5.67 mm vs. 53.20 ± 5.78 mm, p = .03) improved significantly on patients accepting CSP upgrade. CSP responses and complete reverse remodeling (LVEF ≥50% and LVEDD < 50 mm) were detected in 80.95% (17/21) and 42.9% (9/21) of patients. The pacing threshold (1.52 ± 0.78 V/0.4 ms vs. 1.27 ± 0.59 V/0.4 ms, p = .16) was stable after follow-up.
CONCLUSION
PICM is very common in patients with long-term persistent AF, and CSP upgrade was favorable for better cardiac performance in this patient population.
目的
确定起搏诱导性心肌病（PICM）的预测因素，并说明长期持续性心房颤动（AF）患者升级传导系统起搏（CSP）的安全性和可行性。
方法
连续纳入 2008 年 1 月至 2017 年 12 月期间所有长期持续性 AF 和左心室射血分数（LVEF）正常（≥50%）的患者，所有患者均存在房室传导阻滞（AVB）和右心室起搏（RVP）百分比≥40%。确定 PICM 的预测因素，并对无论是否升级 CSP，均至少随访 1 年的 PICM 患者进行随访。所有患者在升级 CSP 前后均进行了心脏功能和导联结局的检查。
结果
本研究共纳入 139 例患者，其中 37 例（26.62%）发生了 PICM，导致左心室射血分数（LVEF）从 56.11±2.56%显著下降至 38.10±5.81%（p<0.01）。PICM 发生的中位时间为 5.43 年。较低的 LVEF（≤52.50%）、较长的起搏 QRS 持续时间（≥175ms）和较高的 RVP 百分比（≥96.80%）被确定为 PICM 的独立预测因素。此外，随着预测因素数量的增加，PICM 的发病率逐渐增加。起搏 QRS 持续时间（183.90±22.34ms 比 136.57±20.71ms，p<0.01）、LVEF（39.35±2.71%比 47.50±7.43%，p<0.01）和左心室舒张末期直径（LVEDD）（55.53±5.67mm 比 53.20±5.78mm，p=0.03）在接受 CSP 升级的患者中显著改善。80.95%（17/21）和 42.9%（9/21）的患者出现 CSP 反应和完全逆向重构（LVEF≥50%和 LVEDD<50mm）。随访后起搏阈值（1.52±0.78V/0.4ms 比 1.27±0.59V/0.4ms，p=0.16）稳定。
结论
PICM 在长期持续性 AF 患者中非常常见，升级 CSP 有利于改善该患者人群的心脏功能。
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