显著的心内电图波形与穿孔在左捆分支区域节奏植入过程中穿孔.
Heli Tolppanen1,2, Valerian Valiton1, Samuel Stempfel1
1Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland.
左捆支部区域节奏 (LBBAP) 穿孔导致损伤电流 (COI) 幅度下降. 分析单极电图 (iEGM) 波形可以帮助识别LBBAP部署期间的穿孔,提高患者的安全.
科学领域:
- 心脏病学 心脏病学
- 电力生理学 电力生理学
- 医疗器械 医疗器械
背景情况:
- 左捆分支区域步调 (LBBAP) 是一种先进的步调技术.
- 在LBBAP植入过程中的穿孔可能会导致并发症.
- 单极电图 (iEGM) 在置过程中提供信号.
研究的目的:
- 在LBBAP穿孔过程中系统分析单极iEGM波形.
- 为了将这些波形与最终领先位置记录的波形进行比较.
- 为了识别特定的波形特征,表明穿孔.
主要方法:
- 来自92名LBBAP穿孔患者的单极iEGM的分析.
- 在穿孔过程中损伤电流 (COI) 幅度和波形形态的比较与最终的领先位置.
- 基于QRS形态 (狭窄/非LBBB与LBBB/节奏节奏) 和穿孔类型 (宏观与微观) 的亚组分析.
主要成果:
- 与最终领先位置 (14.0 mV) 相比,在穿孔过程中 (3.0 mV) 感知到的COI振幅明显较低.
- 患有狭窄QRS/非LBBB的患者表现出QS波形 (67%),而LBBB/节奏节奏患者表现出积极的R/RS形态 (93%).
- 感知到的Q或S振幅大于COI振幅,在狭窄的QRS亚组中,用于诊断穿孔的灵敏度为86%,特异性为93%.
结论:
- 单极iEGM波形分析为LBBAP穿孔提供了超出COI振幅的额外诊断信息.
- 特定的波形形态 (例如,QS在狭窄的QRS中) 可以可靠地表明穿孔.
- 在部署期间仔细监测iEGM波形,提高LBBAP的安全性.
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