Feasibility study of left bundle branch area pacing using simple stylet-driven pacing lead
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摘要: 目的 探讨无指引鞘条件下单纯使用钢丝支撑的电极导线行左束支区域起搏(LBBAP)的可行性、安全性和起搏特征。方法 总共纳入150例患者，在X线指导下应用单纯钢丝塑形支撑的电极导线行LBBAP。记录术中起搏参数、起搏的QRS波群形态及宽度、左心室达峰时间(LVAT)以及手术并发症等。术后追踪患者进行随访，记录电极参数、心电图和术后并发症情况。结果 150例患者中，LBBAP电极植入成功率为76%，术后QRS宽度(118.43±14.02) ms，术中单极阻抗(589.75±60.14)Ω，双极阻抗(731.88±91.86)Ω，感知(12.25±5.73) mV，阈值(0.85±0.27) V。LVAT为(61.72±10.60) ms。114例患者完成12个月随访，均电极参数稳定，无严重手术相关并发症发生。结论 无指引鞘条件下单纯使用钢丝支撑的电极导线行LBBAP安全可行。Abstract: Objective To explore the feasibility, safety, and pacing characteristics of left bundle branch area pacing(LBBAP) using simple stylet-driven pacing lead without a guide sheath.Methods One hundred and fifty patients were enrolled in this study, and LBBAP was performed with a simple stylet-driven pacing lead without a guide sheath under X-ray guidance. The pacing parameters, paced QRS morphology and width, left ventricular activation time and operation complications were recorded.Results Among 150 patients, the success rate of implantation of LBBAP lead was 76%. The postoperative QRS width was(118.43±14.02) ms, the unipolar impedance was(589.75±60.14) Ω, the bipolar impedance was(731.88±91.86) Ω, the sensing was(12.25±5.73) mV, and the threshold was(0.85±0.27) V, the LVAT was(61.72±10.60) ms. A total of 114 patients completed follow-up for 12 months, with stable electrode parameters and no serious surgical related complications.Conclusion It is safe and feasible to use simple stylet-driven pacing lead LBBAP without a guiding sheath.
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Key words:
- left bundle branch area pacing /
- stylet-driven pacing lead /
- pacemaker /
- bradycardia
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图 1 电极导线、钢丝塑形及置入电极内之后的形状
Figure 1. Electrode lead, shaping of steel wire and shape after insertion into the electrode
图 3 术后右前斜30°时显示的电极位置
Figure 3. The position of the electrode lead displayed at a RAO 30 ° after implantation
表 1 150例患者的基线特征
Table 1. Baseline characteristics of 150 patients
例(%), X ± S 项目 数据 男性 60(40.00) 年龄/岁 67.81±10.69 身高/cm 162.30±7.98 体重/kg 64.56±11.02 病因 SSS 89(59.30) 三度AVB 41(27.30) 高度AVB 9(6.00) 二度二型AVB 9(6.00) 更换电极 2(1.30) 既往史 阵发/持续性心房颤动 13(8.67) 冠心病 41(27.33) 高血压 67(44.67) 糖尿病 25(16.67) 肾功能不全 4(2.67) 术前QRS宽度/ms 110.31±29.33 窄QRS 126(84.00) LBBB 9(6.00) RBBB 15(10.00) 心脏超声指标 LAD/mm 35.80±4.93 LVDD/mm 46.61±3.84 LVEF/% 59.27±5.78 IVST/mm 9.03±1.01 LBBB：左束支传导阻滞；RBBB：右束支传导阻滞；LAD：左心房内径。 
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