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左束支区域起搏与右室心内膜下起搏对同一患者血清NT-proBNP水平的影响

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摘要:

目的 观察不同部位(左束支区域和右室心内膜下)心肌起搏对同一患者血清N末端脑钠
肽前体(NT-proBNP)水平的影响。方法 选择2019年1月至2022年8月于郑州大学附属洛阳中心医院
心血管内科行永久起搏器更换同时行心室电极重置术,其中筛选心室起搏比例≥40%,且重置心室电
极时选用3830电极锚定于左束支区域并成功完成左束支区域起搏的患者22例纳入研究。观察患者入院
时、3830电极置入后1周血清NT-proBNP水平的变化。结果 22例患者3830电极起搏、感知参数理想,
术中阴极夺获阈值均<1.2 V/0.42 ms,且QRS波时限均较术前明显缩短,原右室间隔部起搏组分别为
(113.14±9.65)ms vs.(137.9±10.1)ms,原右室心尖部起搏组分别为(111.33±11.02)ms vs.(145.2
±9.7)ms,P<0.01;原右室间隔部起搏患者,左束支区域起搏术后NT-proBNP水平较术前明显下降,
分别为(246.2±40.9)pg/ml vs. (482.3±289.0)pg/ml,P<0.05。术中未发生因静脉穿刺损伤原心房电
极情况,无气胸、严重出血等并发症。结论 左束支区域起搏与右室间隔起搏、右室心尖部起搏相比,
其可同步心脏电活动,降低NT-proBNP水平,改善患者心脏舒张功能。

Abstract:

Objective To observe the influence of different pacing sites [left bundle branch area pacing (LBBaP) and right ventricular subendocardial pacing] on level of serum N-terminal pro-brain natriuretic peptide (NT-proBNP). Methods The patients undergone permanent pacemaker replacement and ventricular electrode replacement were chosen from Department of Cardiovascular Medicine in Luoyang Central Hospital affiliated to Zhengzhou University from Jan. 2019 to Aug. 2022. Among them, the patients (n=22) with ventricular pacing ratio ≥40%, 3830 electrodes anchored at left bundle branch area and successful LBBaP were enrolled in the study. The changes of serum NT-proBNP level were observed at admission and 1 week after 3830 electrode implantation. Results In all 22 patients, 3830 electrode pacing and sensory parameters were ideal with cathodic capture threshold<1.2 V/0.42 ms during the operation. The QRS duration was significantly shorter than that before the operation, and was (113.14±9.65) ms vs. (137.9±10.1) ms in patients with original right ventricular septal pacing and was (111.33±11.02) ms vs. (145.2±9.7) ms in patients with original right ventricular apex pacing (P<0.01). The level of NT-proBNP decreased significantly in patients with original right ventricular septal pacing after LBBaP than before [(246.2±40.9) pg/ml vs. (482.3±289.0) pg/ml, P<0.05]. There were no damage of original atrial electrode due to venipuncture, pneumothorax, severe bleeding and other complications. Conclusion Compared with right ventricular septal pacing and right ventricular apical pacing, LBBaP can synchronize heart electrical activities, reduce serum NT-proBNP level and improve heart diastolic function.

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  • 2008

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