有或无心脏直视手术史患者左束支区域起搏的对比分析。
Comparative analysis of left bundle branch area pacing in patients with and without a history of open-heart surgery.
作者信息
Nohno Yasumasa, Kozu Ryosuke, Ito Kii, Chikazawa Yuta, Maruyama Shusaku, Hasegawa Tomoya, Tsuchiya Hiromi, Tachibana Takahiro, Kimura Hikaru, Yazaki Yoshikazu
机构信息
Department of Cardiology Saku Central Hospital Advanced Care Center Saku Japan.
Department of Cardiology Asama Nanroku Komoro Medical Center Komoro Japan.
出版信息
J Arrhythm. 2025 Jan 30;41(1):e70010. doi: 10.1002/joa3.70010. eCollection 2025 Feb.
BACKGROUND
Left bundle branch area pacing (LBBAP) is widely performed in routine clinical practice. Achieving LBBAP requires deep insertion of the lead into the interventricular septum. LBBAP may be challenging in patients with a history of open-heart surgery (OHS) because of myocardial fibrosis associated with surgical trauma. This study aimed to report the feasibility and safety of performing LBBAP in patients with a history of OHS.
METHODS
This retrospective analysis included patients who underwent successful LBBAP between November 2020 and September 2024, with approval from our institutional review board. LBBAP was performed using a 3830 SelectSecure lead, and pacing parameters were assessed before and after implantation.
RESULTS
One hundred patients were analyzed, including 26 in the OHS group and 74 in the non-OHS group. The success rates of LBBAP were 84.6% in the OHS group and 90.5% in the non-OHS group ( 0.375). Notably, the number of LBBAP lead placements was higher in the OHS group (3.0 ± 2.1 vs. 2.0 ± 1.4, 0.017). The left ventricular activation time in lead V6 was comparable between the groups at implantation (73.6 ± 13.3 ms vs. 75.6 ± 12.1 ms, 0.522). The QRS duration was significantly wider in the OHS group at implantation (131.3 ± 14.6 vs. 121.1 ± 12.3 ms, 0.002), but parameters remained stable at 1 year.
CONCLUSIONS
LBBAP in patients with a history of OHS may present a slightly higher level of technical difficulty, but it is both feasible and safe.
背景
左束支区域起搏（LBBAP）在常规临床实践中广泛开展。实现LBBAP需要将导线深深插入室间隔。由于与手术创伤相关的心肌纤维化，LBBAP在有心脏直视手术（OHS）史的患者中可能具有挑战性。本研究旨在报告在有OHS史的患者中进行LBBAP的可行性和安全性。
方法
本回顾性分析纳入了在2020年11月至2024年9月期间成功进行LBBAP的患者，并获得了我们机构审查委员会的批准。使用3830 SelectSecure导线进行LBBAP，并在植入前后评估起搏参数。
结果
共分析了100例患者，其中OHS组26例，非OHS组74例。OHS组LBBAP的成功率为84.6%，非OHS组为90.5%（P = 0.375）。值得注意的是，OHS组LBBAP导线置入次数更高（3.0±2.1次 vs. 2.0±1.4次，P = 0.017）。两组在植入时V6导联的左心室激动时间相当（73.6±13.3毫秒 vs. 75.6±12.1毫秒，P = 0.522）。OHS组在植入时QRS波时限明显更宽（131.3±14.6毫秒 vs. 121.1±12.3毫秒，P = 0.002），但参数在1年时保持稳定。
结论
有OHS史的患者进行LBBAP可能技术难度稍高，但可行且安全。
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