张斌,乔建忠,汪杰,潘令新,王园,熊恩来

• 1:铜陵市人民医院心血管内科

摘要(Abstract)：

目的 探讨左束支起搏（LBBP）优化心脏再同步化治疗（CRT）的可行性，并评估对心功能的改善效果。方法 纳入2021年1月至2022年3月在铜陵市人民医院心血管内科行LBBP联合左心室心外膜起搏（LVEP）以优化CRT（联合起搏）的心力衰竭患者11例，评估成功率及安全性。比较术前、术中不同起搏方式及术后QRS宽度，随访纽约心脏病协会（NYHA）心功能分级、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）等指标，评估LBBP优化CRT对心功能改善的效果。结果 11例患者平均年龄（68.7±9.5）岁，行联合起搏成功7例。术前、 LVEP、LBBP及联合起搏后心电图平均QRS宽度分别为163.6 ms、151.4 ms、125.7 ms、129.3ms，其中联合起搏QRS宽度分别低于术前（P<0.001）及LVEP(P=0.001)，差异均有统计学意义，但与LBBP比较差异无统计学意义（P>0.05）;LBBP后QRS宽度低于LVEP，差异有统计学意义（P<0.001）。随访3个月后，联合起搏LVEF由术前31.7%上升至38.1%，差异有统计学意义（P=0.018）,NYHA心功能分级、LVEDd及心胸比例均有所下降，但差异均无统计学意义（均P>0.05）。结论 LBBP联合LVEP以优化CRT可行性高，能够改善心脏电同步性及心功能，可能成为后期心力衰竭器械治疗的重要研究方向。

关键词(KeyWords)： 心力衰竭;心脏再同步化治疗;左束支起搏;左心室心外膜起搏;优化

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基金项目(Foundation): 铜陵市卫科研（2021）7号

作者(Author): 张斌,乔建忠,汪杰,潘令新,王园,熊恩来

参考文献(References)：

• [1] Brigno le M,Auricchio A,Baron-Esquivias G,et al. 2013ESC Guidelines on cardiac pacing and cardiac resynchronization therapy:the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology(ESC).Developed in collaboration with the European Heart Rhythm Association(EHRA)[J]. Eur Heart J,2013,34(29):2281-2329. DOI:10.1093/eurheartj/eht150.
• [2] Pappone C，?alovi??，Vicedomini G,et al. Multipoint left ventricular pacing in a single coronary sinus branch improves mid-term echocardiographic and clinical response to cardiac resynchronization therapy[J]. J Cardiovasc Electrophysiol,2015,26(1):58-63. DOI:10.1111/jce.12513.
• [3] Hou X,Qian Z,Wang Y,et al.Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum[J]. Europace,2019,21(11):1694-1702.DOI:10.1093/europace/euz188.
• [4] Wu S,Su L,Vijayaraman P,et al. Left bundle branch pacing for cardiac resynchronization therapy:nonrandomized ontreatment comparison with His bundle pacing and biventricular pacing[J]. Can J Cardiol,2021,37(2):319-328. DOI:10.1016/j.cjca.2020.04.037.
• [5]中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志，2018,46(10):760-789. DOI:10.3760/cma.j.issn.0253-3758.2018.10.004.
• [6]中华医学会心电生理和起搏分会，中国医师协会心律学专业委员会.希氏-浦肯野系统起搏中国专家共识[J].中华心律失常学杂志，2021,25(1):10-36. DOI:10.3760/cma.j.cn.113859-20201110-00290.
• [7]严激.心力衰竭心脏再同步治疗[M].安徽：安徽科学技术出版社，2012:84-94.
• [8] Daubert C,Behar N,Martins RP,et al. Avoiding non-responders to cardiac resynchronization therapy:a practical guide[J]. Eur Heart J,2017,38(19):1463-1472. DOI:10.1093/eurheartj/ehw270.
• [9]李雨薇，刘俊鹏，杨杰孚.希氏束起搏的发展及现状[J].中国介入心脏病学杂志，2019,27(8):462-465. DOI:10.3969/j.issn.1004-8812.2019.08.008.
• [10] Guo J,Li L,Meng F,et al. Short-term and intermediateterm performance and safety of left bundle branch pacing[J]. J Cardiovasc Electrophysiol,2020,31(6):1472-1481. DOI:10.1111/jce.14463.
• [11] Abdelrahman M,Subzposh FA,Beer D,et al. Clinical outcomes of His bundle pacing compared to right ventricular pacing[J]. J Am Coll Cardiol,2018,71(20):2319-2330.DOI:10.1016/j.jacc.2018.02.048.
• [12] Zhang W,Huang J,Qi Y,et al. Cardiac resynchronization therapy by left bundle branch area pacing in patients with heart failure and left bundle branch block[J]. Heart Rhythm,2019,16(12):1783-1790.DOI:10.1016/j.hrthm.2019.09.006.
• [13] Giuseppe Boriani,Wolfgang Kranig,Erwan Donal,et al. A randomized double-blind comparison of biventricular versus left ventricular stimulation for cardiac resynchronization therapy:the biventricular versus left univentricular pacing with ICD back-up in heart failure patients(B-LEFT HF)trial[J]. Am Heart J,2010,159(6):1052-1058. DOI:10.1016/j.ahj.2010.03.008.
• [14]时向民，李健，李世兴，等.左束支优化心脏再同步治疗对老年心力衰竭患者心功能的影响[J].中华老年心脑血管病杂志，2022,24(3):255-259. DOI:10.3969/j.issn.1009-0126.2022.03.009.
• [15] Jastrz?bski M,Moskal P,Huybrechts W,et al. Left bundle branch-optimized cardiac resynchronization therapy(LOTCRT):results from an international LBBAP collaborative study group[J]. Heart Rhythm,2022,19(1):13-21.DOI:10.1016/j.hrthm.2021.07.057.
• [16] Chen X,Ye Y,Wang Z,et al.Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block:a prospective,multi-centre,observational study[J].Europace,2022,24(5):807-816. DOI:10.1093/europace/euab249.
• [17] Rademakers LM,van den Broek JLPM,Bracke FA. Left bundle branch pacing as an alternative to biventricular pacing for cardiac resynchronisation therapy[J]. Neth Heart J,2023,31(4):140-149. DOI:10.1007/s12471-022-01712-9.
• [18] Wang Y,Zhu H,Hou X,et al. Randomized trial of left bundle branch vs. biventricular pacing for cardiac resynchronization therapy[J]. J Am Coll Cardiol,2022,80(13):1205-1216.DOI:10.1016/j.jacc.2022.07.019.