Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Rd, East-lake District, 330006, Nanchang, Jiangxi, China.
Department of Cardiovascular Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 430060, Wuhan, China.
Herz. 2024 Dec;49(6):472-478. doi: 10.1007/s00059-024-05259-w. Epub 2024 Aug 5.
This study aimed to assess the safety of left bundle branch area pacing (LBBAP) by measuring the distance from the tip of the electrode to the nearby coronary artery with a nine-partition grid method.
From January 2019 to October 2020, patients who underwent LBBAP and postoperative coronary angiography in the Second Affiliated Hospital of Nanchang University were included in the study. The patients' fluoroscopic images of LBBAP and coronary angiography were collected and analyzed. Changes in the ST‑T segment in the electrocardiogram (ECG), serum troponin, and myocardial enzyme profiles were observed before and after the LBBAP procedure.
A total of 50 patients were included in this study, of whom 46 patients underwent implantation with a pacemaker and 4 patients received an implantable cardioverter defibrillator (ICD). The pacing electrodes were confined to the posterior-middle (PM), median (M), Posterior inferior (PI), and middle inferior (MI) positions of the two-dimensional nine-square grid or in the junction area of the above positions, and were concentrated in the rectangle formed by the line of the center points of the four positions. The average vertical distances from the electrode tip to the left anterior descending branch artery (LAD), posterior descending branches (PD) and the left posterior ventricular branches (PL) were 19.69 ± 8.72 mm, 26.09 ± 8.02 mm, and 21.11 ± 7.86 mm, respectively; the minimum was 5.28 mm, 9.51 mm, and 8.69 mm, respectively. Coronary angiography in all patients showed no significant injury to the ventricular septal branch; however, we observed elevated serum troponin and changes in ST‑T segment in ECG.
The study demonstrates that pacing electrodes in LBBAP can be safely implanted over a wide range. Coronary arteries are likely to be safe when the pacing electrodes are located within the rectangle formed by the line connecting the PM, M, PI, and MI zone centroids. The left bundle branch can be quickly captured and the safety of the coronary artery can be improved by locating the electrode in the posterior-mid zone. The potential risk of injury to the LAD from the electrode is greater compared with the PD.
本研究旨在通过使用九分区网格方法测量电极尖端到附近冠状动脉的距离来评估左束支区域起搏（LBBAP）的安全性。
本研究纳入了 2019 年 1 月至 2020 年 10 月在南昌大学第二附属医院行 LBBAP 并术后行冠状动脉造影的患者。收集并分析患者 LBBAP 和冠状动脉造影的透视图像。观察 LBBAP 术前和术后心电图（ECG）ST-T 段变化、血清肌钙蛋白和心肌酶谱。
共纳入 50 例患者，其中 46 例行起搏器植入，4 例行植入式心脏复律除颤器（ICD）植入。起搏电极局限于二维九分区网格的后中（PM）、中（M）、后下（PI）和中下（MI）位置或上述位置的交界处，集中在四个位置中心点连线形成的矩形内。电极尖端到左前降支（LAD）、后降支（PD）和左后室支（PL）的平均垂直距离分别为 19.69±8.72mm、26.09±8.02mm 和 21.11±7.86mm，最小距离分别为 5.28mm、9.51mm 和 8.69mm。所有患者的冠状动脉造影均未见室间隔支明显损伤，但观察到血清肌钙蛋白升高和 ECG 中 ST-T 段变化。
本研究表明，LBBAP 中的起搏电极可以在广泛的范围内安全植入。当起搏电极位于连接 PM、M、PI 和 MI 区中心点的连线形成的矩形内时，冠状动脉可能是安全的。将电极定位于后中区域可快速捕获左束支并提高冠状动脉安全性。与 PD 相比，电极对 LAD 的潜在损伤风险更大。
