使用心肌灌注显像术比较在左束支区域起搏中探条驱动和无腔导线技术之间的左心室不同步情况。
Comparison of the left ventricular dyssynchrony between stylet-driven and lumen-less lead technique in left bundle branch area pacing using myocardial perfusion scintigraphy.
作者信息
Miyajima Keisuke, Urushida Tsuyoshi, Tomida Yuichiro, Tamura Takumi, Masuda Sakito, Okazaki Ayako, Kawaguchi Yoshitaka, Wakabayashi Yasushi, Maekawa Yuichiro
机构信息
Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
出版信息
Quant Imaging Med Surg. 2023 Oct 1;13(10):6840-6853. doi: 10.21037/qims-23-357. Epub 2023 Sep 22.
BACKGROUND
Left bundle branch area pacing (LBBAP) has emerged as a novel physiological pacing method to reduce left ventricular (LV) dyssynchrony due to ventricular pacing. Only lumen-less pacing leads (LLLs) with fixed helixes could achieve LBBAP previously, but recently, LBBAP has been performed using stylet-driven leads (SDLs). This study aimed to evaluate the LV dyssynchrony between SDLs and LLLs techniques in LBBAP.
METHODS
We retrospectively evaluated patients who underwent LBBAP with either SDLs or LLLs. We compared both groups' electrocardiogram (ECG) findings and LV dyssynchrony parameters derived from myocardial perfusion scintigraphy. LV dyssynchrony parameters consisted of phase analysis and regional wall motion analysis. We evaluated bandwidth, phase standard deviation (PSD), and entropy in the phase analysis. The time to the end-systolic frame (TES) was calculated in regional wall motion analysis using single-photon emission computed tomography (SPECT). We also evaluated the maximum differences between segmental TES (MDTES), the standard deviation of TES (SDTES), and the difference in the TES between the lateral wall and septum (DTES-LS).
RESULTS
In total, 97 patients were enrolled. The success rate of LBBAP did not differ between the groups [SDLs: 47/48 patients (98%) LLLs: 47/51 patients (92%), P=0.36]. The paced QRS duration and the stimulus to the peak LV activation time (stim-LVAT) also did not differ between SDL and LLL groups (122±10 119±12 ms, P=0.206; 69±12 66±13 ms, P=0.31, respectively). There were no differences in bandwidth, PSD, and entropy between SDL and LLL groups (73°±37° 86°±47°, P=0.18; 19°±8.5° 21°±9.7°, P=0.19; 0.57±0.08 0.59±0.08, P=0.17, respectively). The regional wall motion analysis parameters MDTES, SDTES, and DTES-LS also did not differ between SDL and LLL groups (19%±10% 20%±10%, P=0.885; 5.0%±2.5% 5.0%±2.5%, P=0.995; 5.0%±3.7% 4.8%±4.2%, P=0.78, respectively).
CONCLUSIONS
LBBAP using SDLs was comparable to LV electrical and mechanical synchrony with LLLs.
背景
左束支区域起搏（LBBAP）已成为一种新型的生理性起搏方法，用于减少心室起搏导致的左心室（LV）不同步。此前只有带有固定螺旋的无腔起搏导线（LLL）才能实现LBBAP，但最近，已开始使用探条驱动导线（SDL）进行LBBAP。本研究旨在评估LBBAP中SDL和LLL技术之间的LV不同步情况。
方法
我们回顾性评估了接受SDL或LLL进行LBBAP的患者。我们比较了两组的心电图（ECG）结果以及心肌灌注闪烁显像得出的LV不同步参数。LV不同步参数包括相位分析和室壁运动分析。我们在相位分析中评估了带宽、相位标准差（PSD）和熵。使用单光子发射计算机断层扫描（SPECT）在室壁运动分析中计算收缩末期帧时间（TES）。我们还评估了节段性TES之间的最大差异（MDTES）、TES的标准差（SDTES）以及侧壁与间隔之间的TES差异（DTES-LS）。
结果
总共纳入了97例患者。两组之间LBBAP的成功率没有差异[SDL组：47/48例患者（98%），LLL组：47/51例患者（92%），P = 0.36]。SDL组和LLL组之间的起搏QRS波时限以及刺激到左心室激活峰值时间（stim-LVAT）也没有差异（分别为122±10与119±12 ms，P = 0.206；69±12与66±13 ms，P = 0.31）。SDL组和LLL组之间在带宽、PSD和熵方面没有差异（分别为73°±37°与86°±47°，P = 0.18；19°±8.5°与21°±9.7°，P = 0.19；0.57±0.08与0.59±0.08，P = 0.17）。室壁运动分析参数MDTES、SDTES和DTES-LS在SDL组和LLL组之间也没有差异（分别为19%±10%与20%±10%，P = 0.885；5.0%±2.5%与5.0%±2.5%，P = 0.995；5.0%±3.7%与4.8%±4.2%，P = 0.78）。
结论
使用SDL进行的LBBAP在左心室电和机械同步方面与LLL相当。
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