[1]邓晓奇 汪汉 秦淑娟 刘汉雄 童琳 蔡琳.左束支起搏心电图的特点观察[J].心血管病学进展,2020,(1):93-97.[doi:10.16806/j.cnki.issn.1004-3934.2020.01.025]
　DENG Xiaoqi,WANG Han,QIN Shujuan,et al.Characteristics of Electrocardiogram in Left Bundle Branch Pacing[J].Advances in Cardiovascular Diseases,2020,(1):93-97.[doi:10.16806/j.cnki.issn.1004-3934.2020.01.025]
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左束支起搏心电图的特点观察()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2020年1期
页码:
93-97
栏目:
论著
出版日期:
2020-02-04

文章信息/Info

Title:
Characteristics of Electrocardiogram in Left Bundle Branch Pacing
作者:
邓晓奇 汪汉 秦淑娟 刘汉雄 童琳 蔡琳
(西南交通大学附属医院/成都市第三人民医院,四川 成都 610031)
Author(s):
DENG Xiaoqi;  WANG Han;  QIN Shujuan;  LIU Hanxiong;  TONG LinCAI Lin
(The Affiliated Hospital of Southwest Jiaotong University/The Third People’s Hospital of Chengdu,Chengdu 610031,Sichuan,China)
关键词:
希浦系统; 左束支; 起搏; 心电图
Keywords:
His-Purkinje system; Left bundle branch; Pacing; Electrocardiogram
DOI:
10.16806/j.cnki.issn.1004-3934.2020.01.025
摘要:
目的 通过比较自身心律、左束支起搏、右室心尖部或流出道起搏时心电图的形态和QRS波群时限等，找寻左束支起搏心电图的特征表现。方法 选取拟行左束支起搏42例患者 ，记录标准12导联体表心电图，通过测量，分别比较自身心律、左束支起搏及右室心尖部/右室流出道起搏时QRS波群时限、电轴、形态及ST段的差异。结果 自身心律与左束支起搏相比，QRS波群时限无统计学差异（P=0.49），但与右室心尖部/右室流出道起搏相比，具有显著差异（P<0.000）。左束支起搏组，V1导联呈特征性“M”或“rSR”的比例为76.19%；aVR导联亦可呈特征性“M”或“rSR”表现，比例为78.57%。对于自身心律为右束支阻滞者，左束支区域起搏仅V1导联呈“M”或“rSR”，aVR导联呈QS型，而无特征性“M”或“rSR”表现。与经典的右束支阻滞心电图比较：左束支起搏ST段及T波改变无规律性。结论 左束支起搏心电图QRS波群时限及电轴与自身心律相比无显著差别，V1及aVR导联均可见特征性“M”或“rSR”表现，右束支阻滞患者仅V1导联呈特征性表现，但依靠心电图的特征性“M”或“rSR”改变判断起搏位点有局限性。
Abstract:
Objective To confirm the characteristics of left bundle branch pacing (LBBP) ECG by comparing the morphology and QRS duration of ECG during self rhythm,LBBP, right ventricular apex(RVA)or right ventricular outflow tract(RVOT) pacing. Methods 42 cases undergoingLBBP were selected and the standard 12 lead ECG was recorded. The differences of QRS duration, electrical axis, morphology and ST segment were compared in self rhythm, LBBP and RVA/RVOT pacing. Results There was no significant difference in QRS duration between LBBP and RVA/RVOT(P< 0.000). In LBBP group, 76.19% of leads V 1 showed the characteristic “M”or“rSR”, and 78.57% of leads aVR showed the characteristic“M”or“rSR”. For the patients with right bundle branch block (RBBB), only lead V1 showed “M”or“rSR”, lead aVR showed QS, but no characteristic “M”or“rSR”. Compared with the classic ECG of RBBB, the ST segment and T wave changes of LBBP were not regular. Conclusion There are no significant difference s in QRS duration and electrical axis between LBBP and self rhythm. The characteristicmorphology, “M”or“rSR” can be seen in leads V 1 and aVR, while only lead V1 shows the characteristic performance in patients with RBBB. It is limited to judge pacing sites by the characteristic“M”or“rSR” changes of ECG.

参考文献/References:

[1] Deshmukh P, Casavant DA, Romanyshyn M, et al. Permanent direct His bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation[J]. Circulation,2000,101(8):869-877.

[2] Huang W,Su L,Wu S,et al.Benefits of permanent His bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced ventricular ejection fraction[J].J Am Heart Assoc,2017,6(4):1-113.

[3] Shurrab M ,Healey JS,Haj-Yahia S,et al.Reduction in unnecessary ventricular pacing fails to affect hard clinical outcomes in patients with preserved left ventricular function:a meta-analysis[J].Europace,2017,19(2):282-288.

[4] 郭继鸿.生理性起搏及临床应用[J].心血管病学进展,2006,27(2):114-148.

[5] Kapa S,Bruce CJ,Friedman PA,et al.Advances in cardiac pacing:beyond the transvenous right ventricular apical lead[J].Cardiovasc Ther,2010,28(6):369-379.

[6] Kawashima T,Sasaki H .A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts[J].Surg Radiol Anat,2005,27(3):206-213.

[7] Zanon F,Ellebbogen KA,Dandamudi G,et al.Permanent His-bundle pacing: a systematic literature review and meta-analysis [J]. Europace,2018,20 (11):1819-1826.

[8] Qian Z,Zou F,Wang Y,et al. Perment His bundle pacing in heart failure patients:a systematic review and meta-analysis [J]. Pacing Clin Electrophysiol,2019,42(2):139-145.

[9] George K,Thomas N. Anatomical configuration of the His bundle and bundle branches in the human heart[J].Circulation,1976,53(4):609-620.

[10] Chen XY,Wu SJ,Su L,et al.The characteristics of the electrocardiogram and the i ntracardiac electrogram in left bundle branch pacing[J].J Cardiovasc Electrophysiol,2019,30 (7):1096-1101.

[11] Chen KP, Li YQ.How to implant left bundle branch pacing lead in routine

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更新日期/Last Update: 2020-03-24