左枝区域节奏与心脏再同步治疗的双心室节奏相比,左心室喷射率≤50%的患者:来自国际协作LBBAP研究 (I-CLAS) 的结果
Ramez Morcos1, Pugazhendhi Vijayaraman1, Óscar Cano2
1Geisinger Heart Institute, Wilkes-Barre, Pennsylvania.
Heart rhythm
|April 27, 2025
概括
在CRT患者中,左捆支部区域节奏 (LBBAP) 与双心室节奏 (BVP) 相比,提供了更好的电再同步和更少的心力衰竭住院治疗. 此外,LBBAP还导致了较低的程序并发症.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭管理的管理
背景情况:
- 使用双心室节奏 (BVP) 的心脏再同步疗法 (CRT) 是心力衰竭的标准,其排气分数减少,QRS宽.
- 左捆分支区域节奏 (LBBAP) 通过直接节奏His-Purkinje系统提供了一个生理替代方案.
研究的目的:
- 在接受CRT的LVEF≤50%的患者中,比较LBBAP与BVP的临床结果.
- 评估LBBAP作为CRT策略的有效性和安全性.
主要方法:
- 多中心观测研究 (2018-2023) 包括2579名LVEF≤50%的患者.
- 主要结局:综合所有原因死亡率或心力衰竭住院治疗 (HFH).
- 倾向性得分匹配用于平衡基线特征;进行生存分析.
主要成果:
- 在匹配的队列中 (n=1560),LBBAP显示了更短的节奏QRS持续时间 (129±19毫秒对143±22毫秒).
- LBBAP显著降低了复合结果 (HR 0.81) 和HFH (HR 0.63) 的风险.
- 使用LBBAP观察到较低的手术并发症 (3.5%对6.5%).
结论:
- 与BVP相比,LBBAP表现出优越的电气重同步和降低的HFH.
- 在CRT患者中,LBBAP与LVEF<50%的CRT患者的手术并发症较少相关.
- 需要进一步的随机试验来确认LBBAP的长期益处.
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