左束支传导阻滞患者长期传导系统起搏后，左心室射血分数是心脏功能的决定因素吗？
Left ventricular ejection fraction is a determinant of cardiac performance after long-term conduction system pacing in patients with left bundle branch block?
作者信息
Ma Zhu-Lin, Ma Cheng-Ming, Yang Yi-Heng, Gao Lian-Jun, Xia Yun-Long, Dong Ying-Xue
机构信息
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, No. 222. Zhongshan Road, Dalian, Liaoning Province, China.
Department of Cardiology, Central Hospital of Junger Flag, Ordos, China.
出版信息
BMC Cardiovasc Disord. 2025 Mar 26;25(1):220. doi: 10.1186/s12872-025-04660-5.
OBJECTIVE
This study aims to explore the feasibility, safety, and clinical performance of conduction system pacing (CSP) in patients with left bundle branch block (LBBB) and varying left ventricular ejection fraction (LVEF) values.
METHODS
We consecutively enrolled all patients with LVEF ≤ 35% and LBBB who met the criteria for cardiac resynchronization therapy (CRT) and underwent CSP from January 2018 to December 2021. We compared the differences in improvements in cardiac performance after CSP between patients with LVEF < 25% and those with LVEF between 25 to 35%.
RESULTS
CSP was successfully deployed in 74 out of 80 patients (92.50%), including 32 patients with LVEF < 25% and 42 patients with LVEF 25%-35%. The CSP response rates were similar between the two groups (71.90% vs. 90.50%, P = 0.076), as were the super-response rates (62.50% vs. 78.60%, P = 0.129) and the rates of left ventricular complete reverse remodeling (21.90% vs. 42.90%, P = 0.059) after a follow-up period of 40.81 ± 11.93 months. Significant improvements were observed in LVEF (20.50 ± 2.75% vs. 37.78 ± 13.04%, P < 0.001), left ventricular end-diastolic dimension (LVEDD) (69.56 ± 6.77 mm vs. 59.41 ± 11.00 mm, P < 0.001), left ventricular end-systolic volume (LVESV) (224.81 ± 50.65 ml vs. 134.00 ± 83.35 ml, P < 0.001), NYHA class (3.59 ± 0.48 vs. 1.78 ± 0.66, P < 0.001), and QRS duration (168.75 ± 21.52 ms vs. 117.81 ± 17.09 ms, P < 0.001) in patients with LVEF < 25%. Despite these improvements, the final LVEF (37.78 ± 13.04 vs. 46.19 ± 9.47, P = 0.003) and final LVESV (134.00 ± 83.35 vs. 70.89 ± 38.89, P = 0.001) after CSP were inferior in patients with LVEF < 25%, and the rate of rehospitalization for heart failure was higher in this group (46.90% vs. 21.40%, P = 0.021) compared to those with LVEF between 25 to 35%.
CONCLUSIONS
CSP is feasible and safe for improving clinical outcomes in patients with LVEF < 25%. Timely CSP intervention in patients with LBBB and HF may be beneficial for cardiac performance.
目的
本研究旨在探讨传导系统起搏（CSP）在左束支传导阻滞（LBBB）且左心室射血分数（LVEF）值不同的患者中的可行性、安全性及临床疗效。
方法
我们连续纳入了2018年1月至2021年12月期间符合心脏再同步治疗（CRT）标准且接受CSP的所有LVEF≤35%且伴有LBBB的患者。我们比较了LVEF<25%的患者与LVEF在25%至35%之间的患者在CSP后心脏功能改善方面的差异。
结果
80例患者中有74例（92.50%）成功实施了CSP，其中LVEF<25%的患者32例，LVEF 25% - 35%的患者42例。两组的CSP反应率相似（71.90%对90.50%，P = 0.076），超反应率（62.50%对78.60%，P = 0.129）以及左心室完全逆向重构率（21.90%对42.90%，P = 0.059）在40.81±11.93个月的随访期后也相似。LVEF<25%的患者在LVEF（20.50±2.75%对37.78±13.04%，P<0.001）、左心室舒张末期内径（LVEDD）（69.56±6.77mm对59.41±11.00mm，P<0.001）、左心室收缩末期容积（LVESV）（224.81±50.65ml对134.00±83.35ml，P<0.001）、纽约心脏协会（NYHA）分级（3.59±0.48对1.78±0.66，P<0.001）以及QRS时限（168.75±21.52ms对117.81±17.09ms，P<0.001）方面有显著改善。尽管有这些改善，但CSP后LVEF<25%患者的最终LVEF（37.78±13.04对46.19±9.47，P = 0.003）和最终LVESV（134.00±83.35对70.89±38.89，P = 0.001）较差，且该组心力衰竭再住院率高于LVEF在25%至35%之间的患者（46.90%对21.40%，P = 0.021）。
结论
CSP对于改善LVEF<25%患者的临床结局是可行且安全的。对LBBB和心力衰竭患者及时进行CSP干预可能有利于心脏功能。
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