摘要
Abstract
Objective To compare the application of direct left ventricular septal pacing(DLVSP)and right ventricular apical pacing(RVAP)in treatment of patients with severe atrioventricular block.Methods A total of 106 patients with high and third degree atrioventricular block admitted to our department from January 2021 to October 2023 were randomly assigned to receive DLVSP or RVAP with 53 cases in each group.The baseline conditions,X-ray exposure time,operation time,complications,pacing QRS wave width,threshold and impedance changes,ventricular pacing ratio,B-type natriuretic peptide(BNP)levels,and left ventricular ejection fraction(LVEF)were compared between two groups.Results There were no significant differences in age,gender,comorbidities(hypertension,hyperglycemia,coronary heart disease),BNP levels and LVEF between DLVSP group and RVAP group.There were no significant differences in X-ray exposure time and total electrode implantation time between two groups.The success rate of pacing in the DLVSP group reached 92.45％(49/53),with 61.2％(30/49)meeting the success criteria for left bundle branch pacing and 38.8％(19/49)for left ventricular septal myocardial pacing.The pacing QRS duration in the DLVSP group was significantly shorter than that in the RVAP group(108.5±18.2 ms vs 149.1±10.6 ms,P＜0.05).There were no significant differences in electrode threshold and impedance stability between the two groups during follow-up.Six months after surgery,there was no significant difference in the proportion of ventricular pacing between the two groups.The BNP level in the RVAP group was significantly higher than that in the DLVSP group(278.2±23.6 pg/mL vs 201.7±28.2 pg/mL,P＜0.05),while there was no significant difference in LVEF between the two groups.Conclusion DLVSP does not increase the difficulty and time of surgery for experienced surgeons compared to traditional RVAP.DLVSP also has a preventive effect on postoperative BNP elevation and it may reduce the risk of long-term clinical heart failure,indicating that DLVSP can be used as the preferred placement method for ventricular pacing electrodes.关键词
左室间隔面起搏/右室心尖部起搏/术式/效果Key words
left ventricular septal pacing/right ventricular apex pacing/operative method/effect分类
医药卫生
