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目的 通过单中心回顾性分析,探讨永久希氏束起搏(HBP)的长期安全性和可行性.方法 连续纳入2013年1月至2017年10月在浙江大学医学院附属邵逸夫医院尝试行永久HBP的患者105例,评估永久HBP参数变化和患者临床疗效.研究主要指标为心功能(NYHA分级)和超声心动图结果等指标.结果 成功HBP 88例,其中选择性起搏64例(72.7%),非选择性起搏24例(27.3%).术中希氏束导线阈值(1.3±0.7) V/0.4 ms,感知幅度(4.1±3.5) mV,阻抗(582.7±157.6) Ω.中位随访15个月,希氏束导线阈值、感知幅度差异均无统计学意义.术后患者心功能及超声心动图结果均较基线改善.根据基线左心室射血分数(LVEF),分为射血分数正常组(LVEF≥50%)55例(62.5%)及射血分数下降组(LVEF<50%)33例(37.5%).射血分数下降组中,HBP术后3个月LVEF即有提高,术后1年以上的左心室舒张末期内径(LVEDD)较基线显著缩小.射血分数正常组中,术后3个月的右心室收缩压较术前显著下降,术后1年以上的LVEDD显著缩小,LVEF较术前差异均无统计学意义.随访期间,14例患者再住院,再住院率为15.9%.其中心力衰竭(心衰)再住院11例(12.5%).结论 永久HBP是安全有效的.特别是对于有起搏适应证合并心功能不良的患者,HBP可能是合理选择.

Objective The purpose of this study was to explore the long-term safety and clinical outcomes of permanent His-bundle pacing(HBP). Methods We consecutively recruited 105 patients scheduled to have permanent HBP implantation from January 2013 to December 2017 at Sir Run Run Shaw Hospital,Zhejiang University College of Medicine and explored the parameter changes and clinical outcomes. Results Eighty-eight patients received permanent HBP successfully(64 with selective HBP and 24 with non-selective HBP). In permanent HBP,the acute pacing threshold was(1.3±0.7) V/0.4 ms,and the sensed potentials were(4.1±3.5) mV,and the impedance was(582.7±157.6) Ω. During median follow-up of 15 months,the threshold and the sensed potentials had no significant difference compared with the measurements at implantation respectively. Median NYHA functional class was improved compared with pre-implantation. left ventricular ejection fraction(LVEF)increased from baseline in patients with reduced LVEF(n=33)while no significant change was found in patients with preserved LVEF. The rehospitalization rate was 15.9%(n=14), with 11 patitents due to heart failure. Conclusion Permanent HBP is feasible and safe for patients with a standard pacemaker indication,particularly for the patients with systolic heart failure.