Pei-Pei Ma, Ying Chen, Yi-Heng Yang, Guo-Cao Li, Cheng-Ming Ma, Qing Fa, Lian-Jun Gao, Yun-Long Xia, Ying-Xue Dong
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Physiol. 2024 Jul 23;15:1355696. doi: 10.3389/fphys.2024.1355696. eCollection 2024.
The feasibility of the conduction system pacing (CSP) upgrade as an alternative modality to the traditional biventricular pacing (BiVP) upgrade in patients with pacemaker-induced cardiomyopathy (PICM) remains uncertain. This study sought to compare two modalities of CSP (His bundle pacing (HBP) and left bundle branch pacing (LBBP)) with BiVP and no upgrades in patients with pacing-induced cardiomyopathy. This retrospective analysis comprised consecutive patients who underwent either BiVP or CSP upgrade for PICM at the cardiac department from 2017 to 2021. Patients with a follow-up period exceeding 12 months were considered for the final analysis. The final group of patients who underwent upgrades included 48 individuals: 11 with BiVP upgrades, 24 with HBP upgrades, and 13 with LBBP upgrades. Compared to the baseline data, there were significant improvements in cardiac performance at the last follow-up. After the upgrade, the QRS duration (127.81 ± 31.89 vs 177.08 ± 34.35 ms, < 0.001), NYHA class (2.28 ± 0.70 vs 3.04 ± 0.54, < 0.05), left ventricular end-diastolic diameter (LVEDD) (54.08 ± 4.80 vs 57.50 ± 4.85 mm, < 0.05), and left ventricular ejection fraction (LVEF) (44.46% ± 6.39% vs 33.15% ± 5.25%, < 0.001) were improved. There was a noticeable improvement in LVEF in the CSP group (32.15% ± 3.22% vs 44.95% ± 3.99% ( < 0.001)) and the BiVP group (33.90% ± 3.09% vs 40.83% ± 2.99% ( < 0.001)). The changes in QRS duration were more evident in CSP than in BiVP (56.65 ± 11.71 vs 34.67 ± 13.32, < 0.001). Similarly, the changes in LVEF (12.8 ± 3.66 vs 6.93 ± 3.04, < 0.001) and LVEDD (5.80 ± 1.71 vs 3.16 ± 1.35, < 0.001) were greater in CSP than in BiVP. The changes in LVEDD ( = 0.549) and LVEF ( = 0.570) were similar in the LBBP and HBP groups. The threshold in LBBP was also lower than that in HBP (1.01 ± 0.43 vs 1.33 ± 0.32 V, = 0.019). The improvement of clinical outcomes in CSP was more significant than in BiVP. CSP may be an alternative therapy to CRT for patients with PICM. LBBP would be a better choice than HBP due to its lower thresholds.
对于起搏器诱导性心肌病（PICM）患者，传导系统起搏（CSP）升级作为传统双心室起搏（BiVP）升级的替代方式的可行性仍不确定。本研究旨在比较两种CSP方式（希氏束起搏（HBP）和左束支起搏（LBBP））与BiVP以及未升级治疗对起搏诱导性心肌病患者的影响。这项回顾性分析纳入了2017年至2021年在心脏科因PICM接受BiVP或CSP升级治疗的连续患者。随访期超过12个月的患者纳入最终分析。最终接受升级治疗的患者组包括48例个体：11例接受BiVP升级，24例接受HBP升级，13例接受LBBP升级。与基线数据相比，末次随访时心脏功能有显著改善。升级后，QRS时限（127.81±31.89 vs 177.08±34.35毫秒，<0.001）、纽约心脏协会（NYHA）分级（2.28±0.70 vs 3.04±0.54，<0.05）、左心室舒张末期内径（LVEDD）（54.08±4.80 vs 57.50±4.85毫米，<0.05）和左心室射血分数（LVEF）（44.46%±6.39% vs 33.15%±5.25%，<0.001）均得到改善。CSP组（32.15%±3.22% vs 44.95%±3.99%（<0.001））和BiVP组（33.90%±3.09% vs 40.83%±2.99%（<0.001））的LVEF均有显著改善。CSP组QRS时限的变化比BiVP组更明显（56.65±11.71 vs 34.67±13.32，<0.001）。同样，CSP组LVEF（12.8±3.66 vs 6.93±3.04，<0.001）和LVEDD（5.80±1.71 vs 3.16±1.35，<0.001）的变化比BiVP组更大。LBBP组和HBP组LVEDD（P=0.549）和LVEF（P=0.570）的变化相似。LBBP的起搏阈值也低于HBP（1.01±0.43 vs 1.33±0.32伏，P=0.019）。CSP组临床结局的改善比BiVP组更显著。对于PICM患者，CSP可能是心脏再同步治疗（CRT）的替代疗法。由于LBBP阈值较低，它将是比HBP更好的选择。
