CAJ | 학술논문

目的探讨永久希氏束起搏(HBP)的安全性和可行性.方法对17例有常规心脏起搏适应证或长期依赖右心室起搏伴收缩性心力衰竭的患者,采用4.1F螺旋导线进行永久HBP,门诊随访3～l2个月.结果成功HBP 9例(52.9％),急性期和慢性期的感知、阈值分别为(3.5±1.4) mV、(1.2±0.7)V和(3.4±3.3)mV、(1.7±1.3)V,相互间差异无统计学意义(P＞0.05).9例中有2例心力衰竭伴持续性心房颤动、宽QRS波,其中1例依赖右心室流出道起搏半年,HBP后QRS时限由术前的150、200 ms变为120、160 ms,心功能由术前的Ⅲ级(NYHA分级)变为Ⅰ、Ⅱ级.17例中1例术后出现中等量心包积液,未予处理,随访1年心包积液明显减少.结论永久HBP是安全、可行的,对于有常规心脏起搏适应证并预期心室起搏依赖的慢性收缩性心力衰竭患者,或长期依赖右心室起搏后出现的收缩性心力衰竭患者,永久HBP可能是较佳选择.
목적 탐토영구희씨속기박(HBP)적안전성화가행성.방법 대17례유상규심장기박괄응증혹장기의뢰우심실기박반수축성심력쇠갈적환자,채용4.1F라선도선진행영구HBP,문진수방3～l2개월.결과 성공HBP 9례(52.9％),급성기화만성기적감지、역치분별위(3.5±1.4) mV、(1.2±0.7)V화(3.4±3.3)mV、(1.7±1.3)V,상호간차이무통계학의의(P＞0.05).9례중유2례심력쇠갈반지속성심방전동、관QRS파,기중1례의뢰우심실류출도기박반년,HBP후QRS시한유술전적150、200 ms변위120、160 ms,심공능유술전적Ⅲ급(NYHA분급)변위Ⅰ、Ⅱ급.17례중1례술후출현중등량심포적액,미여처리,수방1년심포적액명현감소.결론 영구HBP시안전、가행적,대우유상규심장기박괄응증병예기심실기박의뢰적만성수축성심력쇠갈환자,혹장기의뢰우심실기박후출현적수축성심력쇠갈환자,영구HBP가능시교가선택.
Objective To explore the safety and feasibility of permanent His-bundle pacing (HBP).Methods Seventeen patients[ ( 11 male,mean age(67.8±9.6)years)with a standard pacemaker(PM) indication or systolic heart failure who have frequent dependence on right ventricular pacing were enrolled between February,2011 and November,2011.A system consisting of a steerable catheter and a4.1 F screw-in lead were used for permanent HBP.Results After initial failure of HBP in the first 7 cases,HBP was successful in 9 patients.The total success rate was 52.9％ (9/17),but the success rate increased to 90％ in the later practice.In permanent HBP pacing,the acute pacing threshold was( 1.2±0.7 )V at pulse duration of O.4msec,and the sensed potentials were (3.5± 1.4) mV.The pacing threshold was ( 1.7 ± 1.3 ) V,and sensed potentials were (3.4±3.3) mV during 5 ～ 14 months follow-up,which were not significantly different compared with the measurements at implantation( P＞0.05 ).The QRS width was( 104.4±23.5 ) ms at implantation and( 108.9±23.7 ) ms at the follow-up,which were similar to the native QRS width( 107.8±27.7)ms.Among them,QRS width was reduced from 150 ms and 200 ms to 120、160 ms in two patients with systolic heart failure( one patient had depended on right ventricular pacing for half a year).In the two patients,cardiac function was improved (from NYHA Class Ⅲ to Class Ⅰ and Ⅱ ) after HBP.No major complications were observed.Conclusion Permanent HBP is feasible and safe,may be a better choice for the patients with systolic heart failure who require permanent PM with anticipated frequent ventricular pacing or who have frequent dependence on right ventricular pacing.