Abstract：Objective To compare the efficacy and safety of left bundle branch pacing and conventional pacing in patients with atrioventricular block. Methods A total of 174 patients with atrioventricular block who were admitted to the Department of Cardiology, Anqing Hospital, Anhui Medical University and underwent cardiac pacemaker implantation from January 2020 to June 2021 were selected as the research objects. The patients were divided into the traditional right ventricular pacing group (right ventricular apex pacing) and the left bundle branch pacing group (left bundle branch pacing) according to random number table method, with 87 cases in each group. Left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), serum brain natriuretic peptide (BNP), pacing parameter threshold, impedance, perception, and QRS duration were compared between the two groups during operation, 1 month, and 12 months after surgery. The left ventricle 12 segments Ts standard deviation (Tsd-12-LV) and the difference between left ventricular lateral wall base segments and right ventricular free wall base systolic velocity peak time（Ts） (Ts-LV-RV), left ventricular filling time(LVFT) and RR interval ratio (LVFT/RR), as well as operation time, radiation exposure time, radiation dose, and patient complications. Results LVEDD and BNP levels in traditional right ventricular pacing group 12 months after surgery were higher than those before surgery and one month after surgery, and the differences were statistically significant (P＜0.05); BNP level in left bundle branch pacing group 12 months after operation was lower than that in traditional right ventricular pacing group, and the difference was statistically significant (P＜0.05). There were statistically significant differences in threshold comparison between two groups at different points, and the perceptual ability 12 months after surgery was higher than that during surgery and one month after surgery, the differences were statistically significant (P＜0.05); the duration of QRS wave in left bundle branch pacing group during operation, 1 month and 12 months after operation were lower than that in traditional right ventricular pacing group during the same period, and the differences were statistically significant (P＜0.05). The Tsd-12-LV, Ts-LV-RV, and LVFT/RR values of the two groups 12 months after surgery were lower than those before surgery, and the differences were statistically significant (P＜0.05); the LVFT/RR in the traditional right ventricular pacing group at 12 months after surgery was lower than that at one month after surgery, and the difference was statistically significant (P＜0.05). The Ts-LV-RV value and LVFT/RR value in the left bundle branch pacing group at 12 months after surgery were lower than those at one month after surgery, and the differences were statistically significant (P＜0.05). Tsd-12-LV, Ts-LV-RV, and LVFT/RR in left bundle branch pacing group were lower than those in traditional right ventricular pacing group at 12 months after surgery, and the differences were statistically significant (P＜0.05). The Ts-LV-RV value in left bundle branch pacing group was lower than that in traditional right ventricular pacing group one month after operation, and the differences were statistically significant (P＜ 0.05). The operation time and radiation exposure time in the left bundle branch pacing group were longer than those in the traditional right ventricular pacing group, and the radiation dose was higher than that in the traditional right ventricular pacing group, the differences were statistically significant (P＜0.05). The incidence of complications in the left bundle branch pacing group was lower than that in the traditional right ventricular pacing group, and the difference was statistically significant (P＜0.05). Conclusion Left bundle branch pacing is better than traditional pacing in reducing the threshold level of atrioventricular block, and the QRS wave is stable. Left bundle branch pacing can avoid the deterioration of cardiac function, maintain normal left ventricular synchrony, and is safe.
陈良川 徐璐 朱贤关 项学军 郑元喜 乔锐▲. 左束支起搏与传统右室起搏对房室传导阻滞患者近期疗效观察及安全性评估[J]. 中国医药导报, 2023, 20(26): 76-81.
CHEN Liangchuan XU Lu ZHU Xianguan XIANG Xuejun ZHENG Yuanxi QIAO Rui▲. Evaluation of efficacy and safety of left bundle branch pacing and traditional right ventricular pacing in patients with atrioventricular block. 中国医药导报, 2023, 20(26): 76-81.
[1] 刘倩，赵卫华.妊娠新发完全性房室传导阻滞的病因及治疗进展[J].海南医学，2022，33（5）：647-651.
[2] 王珍，陈倩，黄容，等.左束支起搏在心力衰竭合并房室传导阻滞患者中的临床疗效初步研究[J].临床心血管病杂志，2022，38（9）：743-748.
[3] 韩霏，宿燕岗.长期右室起搏致心力衰竭的危险因素及预防[J].中国心脏起搏与心电生理杂志，2017，31（4）：364-367.
[4] 杜淦，曹钰尉，唐炯，等.左束支起搏研究进展[J].心血管病学进展，2022，43（8）：687-690，701.
[5] 徐婧，栾颖.左束支起搏的安全性及可行性研究[J].心血管康复医学杂志，2021，30（3）：370-372.
[6] 郭继鸿.房室阻滞部位的心电图诊断（下）[J].临床心电学杂志，2017，26（6）：455-466.
[7] Tracy CM，Epstein AE，Darbar D，et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities：a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [J]. J Am Coll Cardiol，2012，60（14）：1297-1313.
[8] Cai BN，Huang XY，Li LL，et al. Evaluation of cardiac synchrony in left bundle branch pacing：insights from echocardiographic research [J]. J Cardiovasc Electrophysiol，2020， 31（2）：560-569.
[9] 蔡彬妮，李琳琳，黄心怡，等.左束支起搏的心脏电学和机械同步性及中远期导线稳定性研究[J].中国循环杂志，2020，35（1）：55-61.
[10] 常青，鲁大胜，陈元元，等.希氏束起搏和右心室起搏的长期有效性和安全性比较的荟萃分析[J].中国循证心血管医学杂志，2020，12（1）：18-23.
[11] 李孝勇，俞杉，安亚平，等.右心室起搏电极植于左束支区域的心脏再同步化联合房室结消融应用于心力衰竭合并心房颤动患者1例报告[J].中国实用内科杂志，2020，40（12）：1042-1045.
[12] 唐琳梅，李明星，叶强，等.速度向量成像评价右室不同部位起搏对左心房收缩功能及同步性的影响[J].中国超声医学杂志，2020，36（1）：37-39.
[13] 黄於娟，孙立平，蒋芳勇，等.左束支区域起搏与右心室低位间隔部起搏对永久性心脏起搏器植入术患者心功能影响的对比研究[J].实用心脑肺血管病杂志，2021， 29（3）：68-74.
[14] Worsnick SA，Sharma PS，Vijayaraman P. Right ventricularseptal pacing：A paradigm shift [J]. J Innov Card Rhythm Manag，2018，9（5）：3137-3146.
[15] 喻瑜，华伟.希氏-浦肯野系统起搏用于治疗起搏诱导性心肌病的临床研究进展[J].心血管病学进展，2022， 43（6）：481-484.
[16] 蔡迟，华伟，黄灏，等.犬左束支区域起搏与心室不同部位起搏的心电学及急性血流动力学比较研究[J].中国心血管病研究，2022，20（8）：726-731.
[17] Huang W，Su L，Wu S，et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block [J]. Heart，2019，105（2）：137-143.
[18] 彭一鸣，陈林.左束支起搏进行心脏再同步化治疗的疗效研究[J].创伤与急诊电子杂志，2022，10（3）：156-162.
[19] Health Commission of The People’s Republic of China N. National guidelines for diagnosis and treatment of malignant lymphoma 2022 in China （English version）[J]. Chin J Cancer Res，2022，34（5）：425-457.
[20] 赵晶，赵玲，华宝桐，等.左束支起搏治疗心力衰竭的房室间期优化[J].中国心脏起搏与心电生理杂志，2022， 36（2）：110-115.
[21] 英杰，李亚蕊.B型尿钠肽与儿童心血管疾病[J].心血管病学进展，2019，40（4）：613-617.
[22] 朱朝江，魏高辉.临时心脏起搏器植入术对Ⅲ度房室传导阻滞患者的心功能及BNP、cTnI等指标的影响[J].海南医学，2017，28（3）：360-362.
[23] 蔡彬妮，李琳琳，黄心怡，等.左束支起搏的心脏电学和机械同步性及中远期导线稳定性研究[J].中国循环杂志，2020，35（1）：55-61.
[24] Saraiva RM，Mediano MFF，Mendes FS，et al. Chagas heart disease：An overview of diagnosis，manifestations，treatment， and care [J].World J Cardiol，2021，13（12）：654-675.
[25] 刘燕青，赵青，赵亮，等.三度房室传导阻滞患者左束支起搏与右心室间隔部起搏的临床对比研究[J].中华心律失常学杂志，2021，25（2）：151-155.
京公网安备 11010502046598号