左心室下心脏节奏提供了与直接左子分支捕获相同的左心室同步和工作效率
Lukas Poviser1, Petr Stros1, Zachary Whinnett2
1Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Heart rhythm
|January 9, 2026
概括
在心脏再同步治疗 (CRT) 候选人中,左隔膜心肌节奏 (LVSeP) 保持了电同步和血液动力反应,与左束支节奏 (LBBP) 相似. 这表明,当直接捕获LBB具有挑战性时,LVSeP是可行的替代方案.
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 医疗器械
背景情况:
- 左隔膜心肌节拍 (LVSP) 包含在左束枝 (LBB) 捕获困难的区域或LV下心脏位置的节拍.
- 在下降输出节奏过程中,当观察到从LBB节奏 (LBBP) 过渡时,LV下心脏节奏 (LVSeP) 发生.
研究的目的:
- 为了比较LBBP和LVSeP之间的电心室同步和急性血液动力学反应.
- 评估LVSeP作为心脏再同步治疗 (CRT) 的替代节奏策略的疗效.
主要方法:
- 在递减输出节奏过程中从非选择性LBBP (nsLBBP) 转换为LVSeP的连续CRT患者.
- 通过高频心电图 (UHF-ECG) 评估腹腔失调,并通过侵入性静脉血压测量评估急性血液动力学反应.
- 在两个节奏模式期间,对左心室隔膜进行了侵入性心内图谱绘制.
主要成果:
- 在LVSeP和LBBP (159 ± 18 ms与151 ± 15 ms) 之间,QRS持续时间 (QRSd) 没有显著差异.
- 与LBBP相比,LVSeP显示了较长的V6RWPT和节奏后同电间隔,但与LBBP相比,LV同步 (14 ± 5毫秒 vs. 16 ± 6毫秒) 和静脉血压 (121 ± 18毫米升 vs. 122 ± 17毫米升) 类似.
- 心内测绘显示LVSeP和LBBP都通过His-Purkinje系统激活了LV隔膜.
结论:
- 在CRT候选人中,LVSeP保持左心室同步和急性血液动力学反应,类似于直接LBBP.
- 当直接LBBP不可行时,LVSeP代表了一个潜在的有效的替代步调策略.
- 需要进一步的研究来阐明各种左隔膜节拍技术之间的差异.
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