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不同房室传导阻滞部位患者的希氏-浦肯野系统起搏成功率

The success rate of His-Purkinje system pacing in patients with various sites of atrioventricular block

摘要:

目的:评估不同房室传导阻滞(AVB)部位患者行希氏-浦肯野系统起搏(HPSP)的成功率,为AVB患者HPSP方案的选择提供依据。方法:本研究为回顾性病例分析。选取2016年3月至2021年9月于北部战区总医院心血管内科接受心脏永久起搏器置入治疗且需要高比例心室起搏的637例AVB患者,依据心脏电生理检查判断AVB部位。其中前130例(20.4%)进行了希氏束起搏(HBP)的患者为HBP组;后507例(79.6%)进行了HPSP的患者为HPSP组,包括HBP和/或左束支起搏(LBBP)。收集两组的年龄、性别等基本临床信息,分析不同AVB部位及QRS时限患者的HBP或HPSP的成功率。结果:HBP组年龄(66.4±15.9)岁,男性75例(57.7%);HPSP组年龄(66.8±13.6)岁,男性288例(56.8%)。637例AVB患者中,63.0%(401/637)为房室结阻滞;22.9%(146/637)为希氏束内阻滞;14.1%(90/637)为希氏束远段或以下阻滞。总体上,HPSP较HBP的成功率高[93.9%(476/507)比86.9%(113/130), P<0.05]。不同AVB部位的HPSP成功率均高于HBP,并且随着AVB部位由近及远,HBP和HPSP成功率均呈下降趋势。房室结阻滞和希氏束内阻滞患者的HBP成功率均高于希氏束远段或以下阻滞患者HBP成功率[95.2%(79/83)比47.1%(8/17), P<0.001;86.7%(26/30)比47.1%(8/17), P=0.010]。在希氏束远段或以下阻滞患者中,HPSP的成功率高于HBP[87.7%(64/73)比47.1%(8/17), P=0.001]。QRS<120 ms的患者中,94.9%(520/548)的AVB部位在房室结或希氏束内,HBP与HPSP有相似的高成功率[95.6%(109/114)比96.3%(418/434), P=0.943]。QRS≥120 ms的患者中,69.7%(62/89)的AVB部位在希氏束远段或以下,HBP成功率仅为25.0%(4/16),而HPSP成功率达79.5%(58/73)( P<0.001)。 结论:对于QRS<120 ms且房室结或希氏束内阻滞的AVB患者,HBP与HPSP成功率均较高,可以考虑HBP作为首选策略。对于QRS≥120 ms且AVB部位在希氏束远段或以下的患者,HPSP成功率高于HBP,LBBP应作为首选。

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abstracts:

Objective:To evaluate the success rate of His-Purkinje system pacing (HPSP) in patients with various sites of atrioventricular block (AVB) and provide clinical evidence for the selection of HPSP in patients with AVB.Methods:This is a retrospective case analysis. 637 patients with AVB who underwent permanent cardiac pacemaker implantation and requiring high proportion of ventricular pacing from March 2016 to September 2021 in the Department of Cardiology, General Hospital of Northern Theater Command were enrolled. The site of AVB was determined by electrophysiological examination. His bundle pacing (HBP) was performed in the first 130 patients (20.4%) who were classified as the HBP group and HPSP included HBP and/or left bundle branch pacing (LBBP) was performed in later 507 patients (79.6%) and these patients were classified as the HPSP group. The basic clinical information such as age and sex of the two groups was compared, and the success rates of HBP or HPSP in patients with different sites of AVB and QRS intervals were analyzed.Results:The age of HBP group was (66.4±15.9) years with 75 males (57.7%). The age of HPSP group was (66.8±13.6) years with 288 (56.8%) males. Among 637 patients, 63.0% (401/637) had atrioventricular node block; 22.9% (146/637) had intra-His block; 14.1% (90/637) had distal or inferior His bundle block. Totally, the success rate of HPSP was higher than that of HBP [93.9% (476/507) vs. 86.9% (113/130), P<0.05]. In each group of patients with various AVB sites, the success rate of HPSP was higher than that of HBP respectively and both success rates of HBP and HPSP showed a declining trend with the distant AVB site. The success rate of HBP in patients with atrioventricular node block and intra-His block was higher than that in patients with distal or inferior His bundle block [95.2% (79/83) vs. 47.1% (8/17), P<0.001; 86.7% (26/30) vs. 47.1% (8/17), P=0.010]. The success rate of HPSP was higher than that of HBP in patients with distal or inferior His bundle block [87.7% (64/73) vs 47.1% (8/17), P=0.001]. In patients with QRS<120 ms, 94.9% (520/548) of AVB sites were in atrioventricular node or intra-His, and HBP had a similar high success rate with HPSP [95.6% (109/114) vs. 96.3% (418/434), P=0.943] in these patients. In patients with QRS ≥ 120 ms, 69.7% (62/89) of AVB sites were at distal or inferior His bundle, and the success rate of HBP was only 25.0% (4/16), while the success rate of HPSP was as high as 79.5% (58/73), P<0.001. Conclusions:In patients with QRS<120 ms and atrioventricular node block or intra-His block, success rates of HBP and HPSP are similarly high and HBP might be considered as the first choice. In patients with QRS ≥ 120 ms and AVB site at distal or inferior His bundle, the success rate of HPSP is higher than that of HBP, suggesting LBBP should be considered as the first-line treatment option.

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作者: 高阳 [1] 李苗苗 [2] 于海波 [1] 许国卿 [1] 徐白鸽 [1] 武敏 [1] 王娜 [1] 梁延春 [1] 王祖禄 [1] 韩雅玲 [1]
期刊: 《中华心血管病杂志》2022年50卷6期 543-548页 MEDLINEISTICPKUCSCD
栏目名称: 起搏与电生理
DOI: 10.3760/cma.j.cn112148-20220403-00238
发布时间: 2022-07-31
基金项目:
辽宁省重点研发计划联合计划项目 The Key Research and Development Program of Liaoning Province
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