盛琴慧,褚松筠,金汉,陈尔冬,王玉玲,王梓鸣,周菁

• 1:北京大学第一医院心内科

摘要(Abstract)：

目的总结北京大学第一医院前50例希浦系统起搏病例,为初期开展此项技术提供临床借鉴。方法回顾性分析2019年4-12月本中心同一术者团队行希浦系统起搏操作的前50例患者资料及手术和随访情况。按起搏部位分为希氏束起搏(HBP)组、左束支区域起搏(LBBP)组、室间隔内起搏(IVSP)组,比较各组间的手术操作、起搏结果和参数随访情况。结果按患者手术先后顺序每10例患者一组,共分为5组。随着手术例数的增加,希浦系统起搏的成功率从前10例的50%上升至最后10例的90%,而手术时间显著缩短[(152.7±55.1)min比(89.8±37.7)min, P=0.037],完成20例手术后,成功率稳定在80%以上较好的水平。按照最终起搏的结果,IVSP组15例、HBP组10例、LBBP组25例。左心室激动时间(LVAT),HBP组[(79.4±8.2)ms比(96.0±19.2)ms,P=0.012]和LBBP组[(81.5±13.5)ms比(96.0±19.2)ms,P=0.013]均显著短于IVSP组,差异均有统计学意义;而HBP组和LBBP组[(79.4±8.2)ms比(81.5±13.5)ms,P=0.928]比较,差异无统计学意义。起搏QRS波时限,HBP组[(106.4±19.9)ms比(138.8±18.9)ms,P<0.001]和LBBP组[(118.9±12.3)ms比(138.8±18.9)ms,P<0.001]均显著短于IVSP组,差异均有统计学意义;LBBP组较HBP组延长[(118.9±12.3)ms比(106.4±19.9)ms,P=0.030],差异有统计学意义。但HBP组的起搏阈值显著高于IVSP组[(1.4±0.5)V比(0.6±0.3)V,P<0.001]和LBBP组[(1.4±0.5)V比(0.7±0.2)V,P=0.019],差异均有统计学意义。感知R波则HBP组显著低于IVSP组[(5.7±2.1)mV比(10.2±5.3)mV,P=0.009]和LBBP组[(5.7±2.1)mV比(9.6±2.2)mV,P<0.001]。而LBBP组和IVSP组各项起搏参数均无差异。各组随访期间,起搏阈值和感知R波均无明显变化。手术操作中我们采用了影像法辅助希氏束及左束支区域的解剖定位。结论本中心回顾分析显示,第20～50例的手术操作,可以较熟练掌握希浦系统起搏技术。LBBP可作为初期开展希浦系统起搏的首选。影像解剖定位法可简化手术流程,避免对希氏束和传导束的损伤。

关键词(KeyWords)： 希浦系统起搏;希氏束起搏;左束支区域起搏

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 盛琴慧,褚松筠,金汉,陈尔冬,王玉玲,王梓鸣,周菁

参考文献(References)：

• [1] Vijayaraman P, Dandamudi G, Zanon F, et al. Permanent his bundle pacing:recommendations from a multicenter, his bundle pacing collaborative working group for standardization of defi nitions, implant measurements, and follow-up. Heart Rhythm, 2018,15(3):460-468.
• [2] Huang WJ, Su L, Wu SJ, et al. A novel pacing strategy with low and stable output:pacing the left bundle branch immediately beyond the conduction block. Can J Cardio, 2017,33(12):1736.e1-1736.e3.
• [3] Huang WJ, Chen XY, Su L, et al. A Beginner's guide to permanent left bundle branch pacing. Heart Rhythm, 2019,16(12):1791-1796.
• [4] Vijayaraman P, Chung MK, Dandamudi G, et al. His bundle pacing. J Am Coll Cardiol, 2018,72(8):927-947.
• [5] Scherlag BJ, Papaila A. Permanent his bundle pacing to replace biventricular pacing for cardiac resynchronization therapy.Medical Hypotheses, 2017,109:77-79.
• [6]李雨薇，刘俊鹏，杨杰孚.希氏束起搏的发展及现状.中国介入心脏病学杂志，2019,27(8):462-465.
• [7] Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His-bundle pacing:Long-term lead performance and clinical outcomes. Heart Rhythm, 2018,15(5):696-702.
• [8] Vijayaraman P, Subzposh FA, Naperkowski A. Prospective evaluation of feasibility, electrophysiologic and echocardiographic characteristics of left bundle branch area pacing. Heart Rhythm,2019,16(12):1774-1782.
• [9] Kawashima T, Sasaki H. A Macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg Radiol Anat, 2005,27(3):206-213.
• [10] Gu M, Hu YR, Hua W, et al. Visualization of tricuspid valve annulus for implantation of His bundle pacing in patients with symptomatic bradycardia. J Cardiovasc Electrophysiol.2019,30(10):2164-2169.