CAJ | 학술논문

目的：初步探讨右束支旁起搏电极导线的植入方法，并评价其可行性和安全性。方法50例病态窦房结综合征患者，在右束支电位标测引导下，将右心室起搏电极固定于右束支旁，记录心室起搏电极植入术中尝试位点次数和X线曝光时间。术后1d、3个月、6个月和1年测试起搏电极参数，同时测量自身、右束支夺获和非夺获心电图QRS波时限进行对比分析。结果50例患者中41患者成功将右心室起搏电极植入到右束支旁，并能稳定夺获右束支，成功率为82%；尝试位点次数为（5.2±1.5）次，心室电极植入X线曝光时间为（30.0±8.3）min。右心室起搏电极参数测试结果显示：感知和阻抗稳定；右束支夺获阈值明显高于心室起搏阈值（P＜0.001）；心室起搏阈值和右束支夺获阈值在前6个月轻微增高，6个月以后趋于稳定。右心室起搏（夺获和非夺获右束支）心电图QRS波时限较自身心电图QRS波时限明显增宽（P＜0.001）；起搏夺获右束支心电图QRS波时限较非夺获右束支心电图QRS波时限缩短（P＜0.001）。起搏夺获右束支心脏同步性指标优于非夺获右束（P＜0.001）；与术前相比，1年随访时，左心室舒张末内径和左心室射血分数无明显变化（P＞0.05）。结论右束支旁起搏是一种生理性的心室起搏位点，通过右束支电位标测指导右束支旁起搏电极导线植入安全可行。
목적：초보탐토우속지방기박전겁도선적식입방법，병평개기가행성화안전성。방법50례병태두방결종합정환자，재우속지전위표측인도하，장우심실기박전겁고정우우속지방，기록심실기박전겁식입술중상시위점차수화X선폭광시간。술후1d、3개월、6개월화1년측시기박전겁삼수，동시측량자신、우속지탈획화비탈획심전도QRS파시한진행대비분석。결과50례환자중41환자성공장우심실기박전겁식입도우속지방，병능은정탈획우속지，성공솔위82%；상시위점차수위（5.2±1.5）차，심실전겁식입X선폭광시간위（30.0±8.3）min。우심실기박전겁삼수측시결과현시：감지화조항은정；우속지탈획역치명현고우심실기박역치（P＜0.001）；심실기박역치화우속지탈획역치재전6개월경미증고，6개월이후추우은정。우심실기박（탈획화비탈획우속지）심전도QRS파시한교자신심전도QRS파시한명현증관（P＜0.001）；기박탈획우속지심전도QRS파시한교비탈획우속지심전도QRS파시한축단（P＜0.001）。기박탈획우속지심장동보성지표우우비탈획우속（P＜0.001）；여술전상비，1년수방시，좌심실서장말내경화좌심실사혈분수무명현변화（P＞0.05）。결론우속지방기박시일충생이성적심실기박위점，통과우속지전위표측지도우속지방기박전겁도선식입안전가행。
Objective To explore the methods for implantation of para-right bundle branch (para-RBB) pacing lead and to evaluate the reliability and feasibility. Methods Fifty patients who need implant pacemakers for suffering from sick sinus syndrome were implanted the right ventricular pacing leads at the region of para-RBB by RBB potential mapping. Clinical data, fluoroscopic exposure time for the para-RBB pacing leads implantation and testing pacing sites of each patient were collected. Pacing leads parameters and QRS width were measured on 1 day, 3 months, 6 months and 1 year after the operation. Results Forty-one patients were successfully implanted the ventricular pacing leads at para-RBB. Mean fluoroscopic exposure time was (30.0±8.3) min, and attempting pacing sites were (5.2±1.5) times. Parameters of sense and impedance were stable. The threshold of capture RBB was higher than pacing ventricle (P<0.001). The thresholds of pacing ventricle and capture RBB were increasing slightly during first 6 months, and thereafter were stable. The width of ventricle pacing (capture/non-capture RBB) QRS was longer than intrinsic QRS (P<0.001). And the width of capture RBB QRS was shorter than non-capture RBB QRS (P<0.001). The cardiac synchronization index of pacing by capture of RBB was better than pacing by non-capture of RBB (P<0.001), and there were no differences in the cardiac structure and function between pacing by capture of RBB for 1 year and before operation (P>0.05). Conclusion Para-right bundle branch pacing is a new physiological pacing site. By means of mapping the RBB potential, the ventricular pacing leads can be screwed at the region of para-RBB of right ventricular septum. And this application is safe and feasible.