Comparison of the influence of left bundle area branch pacing and right ventricular septum pacing on tricuspid regurgitation
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摘要: 目的 探索左束支区域起搏(LBBAP)与右室间隔部起搏(RVSP)两种不同起搏模式对三尖瓣反流(TR)的影响。方法 本研究为回顾性观察性研究，纳入2018年1月—2021年8月在张家港市第一人民医院因缓慢性心律失常首次植入心脏永久起搏器，且术前2周内与术后1年以上超声心动图资料齐全的患者。根据心室电极植入部位的不同分为LBBAP组及RVSP组。分析并比较两组术后TR程度。结果 共入组104例患者，男性69例(66.3%)，中位随访时间28.5(17~36.75)个月。其中LBBAP组52例，RVSP组52例。术后TR加重的共有21例(20.2%)，新发TR共10例(9.6%)。其中LBBAP组TR加重的共10例，RVSP组TR加重的共11例，组间比较差异无统计学意义(P=0.807和1.0)。同时观察到LBBAP组术前19例存在轻度以上的TR，术后有14例(73.7%)患者发生TR减轻，RVSP组术前17例存在轻度以上的TR，术后有6例(35.3%)患者发生TR减轻，组间比较差异有统计学意义(P=0.021)。结论 术前即存在TR的患者，LBBAP术后对原有TR的改善程度明显优于RVSP。Abstract: Objective To explore the influence of left bundle branch area pacing(LBBAP) and right ventricular septum pacing(RVSP) on tricuspid regurgitation(TR).Methods This retrospective observational study included patients who received permanent cardiac pacemaker implantation for the first time due to bradycardia in the First People's Hospital of Zhangjiagang from January 2018 to August 2021, and whose echocardiogram data were complete within 2 weeks before operation and more than 1 year after operation. The patients were divided into LBBAP group and RVSP group. The postoperative effects on TR were analyzed and compared.Results A total of 104 patients were enrolled, including 69 males(66.3%). The median follow-up time was 28.5 months. There were 21 patients(20.2%) with aggravated TR and 10 patients(9.6%) with new TR. There were 10 cases of TR aggravation in LBBAP group and 11 cases of TR aggravation in RVSP group, without statistical difference(P=0.807 or 1.0). Meanwhile, 19 patients in the LBBAP group had mild or above TR before operation, and 14 patients(73.7%) had reduced TR after operation; 17 patients in the RVSP group had mild or above TR before operation, and 6 patients(35.3%) had reduced TR after operation. There was statistical difference between the two groups(P=0.021).Conclusion The LBBAP is recommended especially for patients with TR before operation.
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表 1 两组基线资料比较
Table 1. General data
例(%), X±S, M(P25, P75) 项目 LBBAP组(52例) RVSP组(52例) P值 年龄/岁 71.65±11.26 76.46±9.43 0.020 男性 35(67.3) 34(65.4) 0.836 起搏适应证 0.216 病态窦房结综合征 7(13.4) 14(26.9) 0.087 房室传导阻滞 37(71.2) 30(57.7) 0.152 房颤长间歇 8(15.4) 8(15.4) 1.000 合并疾病 高血压 28(53.8) 35(67.3) 0.160 糖尿病 15(28.9) 6(11.5) 0.028 脑梗死 9(17.3) 6(11.5) 0.402 随访时间/月 14(13，14) 12.5(10，14) 0.416 术前LVEF/% 62.67±10.39 64.38±6.37 0.314 术前LVEDD/mm 48.63±5.54 48.63±4，27 1.000 术前proBNP/ (mg/mL) 1 107.38± 2 164.23 884.41± 1 521.19 0.738 基线TR程度 0.557 无 33(63.5) 35(67.3) 轻度 8(15.4) 10(19.2) 中度 11(21.1) 7(13.5) 基线MR程度 0.305 无 34(65.4) 35(67.3) 轻度 16(30.8) 14(26.9) 中度 2(3.8) 3(5.8) 
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表 2 TR减轻患者术前术后超声心动图参数
Table 2. Echocardiographic parameters of patients with TR remission
X±S 参数 术前 术后 P LVEDD/mm 50.30±4.55 46.95±4.95 0.002 LVESD/mm 32.45±3.03 30.15±3.57 0.000 LVEF/% 63.90±4.39 64.55±3.59 0.499 肺动脉压力/mmHg 51.20±12.47 32.80±7.49 0.000
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