Xu Nan, Cheng Xiaoping, Ren Lei, Yuan Quan
Department of Cardiology, The First People's Hospital of Neijiang, Neijiang, China.
Department of Ultrasonic Medicine, The First People's Hospital of Neijiang, Neijiang, China.
Front Cardiovasc Med. 2025 Jan 3;11:1484520. doi: 10.3389/fcvm.2024.1484520. eCollection 2024.
More than 1 million permanent pacemakers are implanted worldwide each year, half of which are in patients with high-grade atrioventricular block. Pacemakers provide adequate frequency support in the initial stage, but traditional right ventricular (RV) pacing may lead to or aggravate left ventricular dysfunction and arrhythmia. Several potential risk factors for heart failure and arrhythmias after pacemaker surgery have been identified, but their occurrence remains difficult to predict clinically. Compared with RV pacing, His bundle pacing (HBP) and left bundle branch pacing (LBBP) activate the intrinsic His-Purkinje conduction system and provide physiological activation, but whether HBP and LBBP also cause ventricular mechanical dyssynchrony remains uncertain. The implantation of cardiac resynchronization therapy and implantable cardioverter defibrillator depends on left ventricular ejection fraction (LVEF). LVEF This depends on volume changes and is less reproducible. Speckle tracking echocardiography (STE) is a technique that can accurately quantify the degree and duration of systolic deformation. STE detects changes in myocardial function more sensitively than traditional measures of diastolic and systolic function, including LVEF. Clinicians can evaluate myocardial strain and synchrony based on strain (percent change in segmental length from baseline) and strain rate (strain per unit time). This review and case series investigate the clinical use of speckle tracking echocardiography in pacemaker implantation.
每年全球植入超过100万个永久性起搏器，其中一半用于患有高度房室传导阻滞的患者。起搏器在初始阶段能提供足够的频率支持，但传统的右心室（RV）起搏可能导致或加重左心室功能障碍和心律失常。已确定了起搏器手术后心力衰竭和心律失常的几个潜在危险因素，但其发生在临床上仍难以预测。与RV起搏相比，希氏束起搏（HBP）和左束支起搏（LBBP）激活固有希氏-浦肯野传导系统并提供生理性激动，但HBP和LBBP是否也会导致心室机械不同步仍不确定。心脏再同步治疗和植入式心律转复除颤器的植入取决于左心室射血分数（LVEF）。LVEF 这取决于容积变化，且重复性较差。斑点追踪超声心动图（STE）是一种能够准确量化收缩期变形程度和持续时间的技术。STE比包括LVEF在内的传统舒张期和收缩期功能测量方法更能敏感地检测心肌功能变化。临床医生可以根据应变（节段长度相对于基线的百分比变化）和应变率（单位时间的应变）来评估心肌应变和同步性。本综述和病例系列研究了斑点追踪超声心动图在起搏器植入中的临床应用。
