实时三维超声心动图评估左束支起搏术对左心室同步性及心室功能的影响

目的 实时三维超声心动图（RT-3DE）评估左束支区域起搏（LBBP）与右心室流出道起搏（RVOP）手术前后患者左右心室收缩功能及左心室同步性。 方法 纳入西安交通大学第二附属医院永久起搏器置入患者56例，根据不同术式分为LBBP组（n=30）和RVOP组（n=26）。应用三维超声心动图获取两组患者术前及术后左右心室收缩功能以及左室同步性参数，比较两组患者手术前后及两组之间的差异。 结果 术后6个月随访，RVOP组LV-GLS较术前降低（P<0.05）；患者左心室16节段同步性参数Tmsv16-SD、Tmsv16-SD%、Tmsv16-Dif、Tmsv16-Dif%较术前均明显增大（均P<0.01）；右心室收缩功能减低，TAPSE（P<0.01）、3D-RVEF（P<0.05）较术前下降。术后6个月随访，LBBP组LV-GLS值高于RVOP组（P<0.05），左心室16节段同步性参数Tmsv16-SD（P<0.05）、Tmsv16-SD%（P<0.01）、Tmsv16-Dif（P<0.01）、Tmsv16-Dif%（ P<0.05）均明显减小，右心室收缩功能指标TAPSE（P<0.01）、3D-RVEF（P<0.05）高于RVOP术后组。 结论 早期随访显示相较于右心室流出道起搏方式，左束支起搏在改善左心室机械同步性更具优势，可维持良好的左心室及右心室收缩功能。

Effects of left bundle branch pacing on left ventricular synchrony and ventricular function assessed by real-time three-dimensional echocardiography

AIM To analyze left and right ventricular systolic functions and left ventricular synchrony before and after left bundle branch pacing (LBBP) and right ventricular outflow tract pacing (RVOP) by three-dimensional echocardiography. METHODS Fifty-six patients with permanent pacemaker implantation were selected and divided into LBBP group and RVOP group according to different surgical procedures. Three-dimensional echocardiography was used to obtain the parameters of left and right ventricular systolic functions and left ventricular synchrony, and differences between the two groups were analyzed. RESULTS After 6 months follow-up in ICU, lv-gls in rvop group was lower than that before operation (P<0.05); The left ventricular 16 segment synchronization parameters tmsv16 SD, tmsv16 SD%, tmsv16 DIF and tmsv16 dif% were significantly higher than those before operation (all P<0.01); Right ventricular systolic function decreased, TAPSE (P<0.01) and 3d-rvef (P<0.05) decreased compared with those before operation. After 6 months of follow-up, the lv-gls value in lbbp group was higher than that in rvop group (P<0.05), the left ventricular 16 segment synchronization parameters tmsv16 SD (P<0.05), tmsv16 SD% (P<0.01), tmsv16 dif (P<0.01), tmsv16 dif% (P<0.05) were significantly decreased, and the right ventricular systolic function indexes TAPSE (P<0.01) and 3d-rvef (P<0.05) were higher than those in rvop group. CONCLUSION Early follow-up shows that compared with right ventricular outflow tract pacing, left bundle branch pacing has more advantages in improving left ventricular mechanical synchronization, which can maintain good left ventricular and right ventricular systolic function.