从传统的右心室节奏到左束枝区域节奏的实践范围的切换的影响
David Fritz1, Ben Ose1, Hannah Zerr1
1The University of Kansas School of Medicine, Kansas City, KS, USA.
概括
与右心室加速 (RVP) 相比,切换到左束支部区域加速 (LBBAP) 没有显示任何不良影响. LBBAP导致了更窄的节奏QRS持续时间和更少的节奏诱导心肌病 (PICM).
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械技术 医疗器械技术
背景情况:
- 节奏诱导心肌病 (PICM) 是传统的右心室节奏 (RVP) 的一个问题.
- 左捆分支区域加速 (LBBAP) 正在成为RVP的潜在优越替代品.
- 从RVP到LBBAP的整个实践过渡是在一个中心实施的.
研究的目的:
- 评估从RVP到LBBAP的实践范围的切换的临床影响和安全性.
- 为了比较接受LBBAP的患者和以前接受RVP的患者之间的结果.
- 评估LBBAP对节奏参数和心脏功能的影响.
主要方法:
- 追溯审查将LBBAP患者 (2020-2023) 与RVP对照 (2018-2019) 的比较.
- 分析基线特征,植入物/光学时间,节奏QRS持续时间,传感,阻抗和捕获值.
- 评估与设备相关的不良事件,全因死亡率和心力衰竭住院情况.
主要成果:
- LBBAP组的植入和光镜时间较长,但实现了更窄的QRS持续时间 (122 ± 20毫秒对145 ± 24毫秒).
- 在LBBAP和RVP组之间,与设备相关的不良事件,全因死亡率或心力衰竭住院病例没有显著差异.
- 与RVP相比,在高心室节奏负担 (≥20%) 的患者中,LBBAP与改善的LVEF和减少的左心室内径变化有关.
结论:
- 在整个实践中切换到LBBAP并没有产生不良后果.
- LBBAP提供了一些好处,包括更窄的QRS持续时间和潜在的缓解PICM.
- LBBAP是RVP的安全有效替代品,特别是在具有显著节奏要求的患者中.
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