左束支区域起搏改善起搏器依赖患者的左心房结局：一项使用斑点追踪和三维超声心动图的前瞻性队列研究。

Left Bundle Branch Area Pacing Improves Left Atrial Outcomes in Pacemaker-Dependent Patients: A Prospective Cohort Study Using Speckle Tracking and Three-Dimensional Echocardiography.

作者信息

Mei Yingchen, Han Rui, Cheng Liting, Wang Zefeng, He Yihua, Liu Wei, Wu Yongquan

机构信息

Department of Cardiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, People's Republic of China.

Cardiac Pacing and CIED Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.

出版信息

Ther Clin Risk Manag. 2025 Sep 13;21:1343-1358. doi: 10.2147/TCRM.S481237. eCollection 2025.

DOI:10.2147/TCRM.S481237

PMID:40969185

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12442809/

Abstract

PURPOSE

Evidence that left bundle branch area pacing (LBBAP) is more effective than conventional right ventricular (RV) pacing in enhancing left atrial (LA) outcomes is lacking. The aim of this study was to investigate LA outcomes using 2-dimensional speckle tracking echocardiography (2D-STE) and real-time 3-dimensional echocardiography (RT-3DE) at 6-months of follow-up in patients that received LBBAP, RV septal pacing (RVSP), or RV apical pacing (RVAP).

METHODS

A total of 90 patients with normal left ventricular ejection fraction (LVEF) underwent dual-chamber pacemaker implantation for bradycardia at Beijing Anzhen Hospital between January 2021 and July 2021. Patients were divided into three groups based on the pacing site: LBBAP, RVSP, or RVAP.

RESULTS

There were no significant differences in baseline characteristics and echocardiographic findings among patients that received LBBAP, RVSP, or RVAP. At 6-months of follow-up, left atrial volume index (LAVI), LA reservoir strain (LASr), LA contractile strain (LASct), global longitudinal strain (GLS), global circumferential strain (GCS), and synchronization parameters (Tmsv-16SD, Tmsv-12SD, Tmsv-6SD, longitudinal Tε-dif, circumferential Tε-dif) were significantly improved in patients that received LBBAP, while they had significantly worsened with RVSP and RVAP. Compared to baseline, at 6-months of follow-up, patients that received LBBAP had significantly improved LASr (28.17±10.12% vs 35.4±17.17%, =0.024), LASct (-12.03±2.15% vs -17.53±7.37%, =0.045), E/e' ratio(12.61±3.8 vs 10.85±3.75,P=0.014) and LVEF (65.74±7.90% vs 68.81±5.92%, =0.023). The 6-minute walking distance significantly increased at 6-months of follow-up compared to baseline in all patients, but the increase was most prominent for LBBAP (403.00±98.46 m vs. 469.34±59.32m, =0.015). LBBAP was associated with a lower risk of new-onset atrial fibrillation.

CONCLUSION

In pacemaker-dependent patients, LBBAP achieved better LA strain, LV strain, and LV synchronization than RVSP or RVAP at 6-months of follow-up.

摘要

目的

缺乏证据表明左束支区域起搏（LBBAP）在改善左心房（LA）结局方面比传统右心室（RV）起搏更有效。本研究的目的是在接受LBBAP、右心室间隔起搏（RVSP）或右心室心尖起搏（RVAP）的患者随访6个月时，使用二维斑点追踪超声心动图（2D-STE）和实时三维超声心动图（RT-3DE）研究LA结局。

方法

2021年1月至2021年7月期间，在北京安贞医院，共有90例左心室射血分数（LVEF）正常的患者因心动过缓接受双腔起搏器植入。根据起搏部位将患者分为三组：LBBAP、RVSP或RVAP。

结果

接受LBBAP、RVSP或RVAP的患者在基线特征和超声心动图检查结果方面无显著差异。随访6个月时，接受LBBAP的患者左心房容积指数（LAVI）、左心房储备应变（LASr）、左心房收缩应变（LASct）、整体纵向应变（GLS）、整体圆周应变（GCS）和同步参数（Tmsv-16SD、Tmsv-12SD、Tmsv-6SD、纵向Tε-dif、圆周Tε-dif）显著改善，而RVSP和RVAP患者则显著恶化。与基线相比，随访6个月时，接受LBBAP的患者LASr显著改善（28.17±10.12%对35.4±17.17%，P=0.024），LASct（-12.03±2.15%对-17.53±7.37%，P=0.045），E/e'比值（12.61±3.8对10.85±3.75，P=0.014）和LVEF（65.74±7.90%对68.81±5.92%，P=0.023）。所有患者随访6个月时6分钟步行距离较基线均显著增加，但LBBAP增加最为显著（403.00±98.46米对469.34±59.32米,P=0.015）。LBBAP与新发房颤风险较低相关。