| Objective:The purpose of this study is to explore the feasibility and safety of left bundle branch pacing in patients with high atrioventricular block,and to compare the characteristics of left bundle branch pacing and right ventricular pacing by retrospective analysis,so as to guide the choice of treatment options in clinical application.Methods:This study retrospectively analyzed the clinical data of 221 patients with high atrioventricular block undergoing permanent pacemaker implantation(including right ventricular pacing and left bundle branch regional pacing)in the cardiovascular diagnosis and treatment center of the first hospital of Jilin University from January 2019 to December 2020,and excluded 47 patients who did not meet the inclusion criteria(27patients had incomplete data,8 patients had a history of cardiac surgery,1patient had a history of Tavi surgery),According to the procedure,174 patients were divided into RVP group(n = 100)and LBBP group(n = 74).The general clinical conditions,operation time,ECG changes before and after operation,pacing parameters(including pacing threshold,pacing perception,pacing impedance),incidence of adverse events and rehospitalization rate of the two groups were recorded,and the intraoperative and postoperative complications of the two groups were observed.SPSS 24.0 software was used to analyze the collected data.Measurement data are expressed as mean ± The comparison between the two groups of data was in accordance with the normal distribution using the independent sample t test,not in line with the normal distribution using the rank sum test.The count data was expressed as the number of cases(percentage%).Chi square test was used for comparison between the two groups,and P < 0.05 was taken as the difference.Results:(1)There was no significant difference in gender,age,preoperative QRS interval,preoperative QRS interval,preoperative LVEF value,preoperative left ventricular end diastolic diameter,complete left bundle branch block,coronary heart disease,diabetes,heart failure,hypertension,stroke,hyperthyroidism and hypothyroidism between RVP group and LBBP group(P > 0.05).(2)There was no significant difference in the incidence of adverse events,ventricular electrode dislocation,pericardial effusion or tamponade,stroke and pneumothorax between RVP group and LBBP group(P > 0.05).The rehospitalization rate within 3 months after operation in RVP group was significantly higher than that in LBBP group(P < 0.05).(3)The results of this study showed that there was no significant difference in preoperative QRS interval between RVP group and LBBP group(P > 0.05).The difference of postoperative QRS interval and preoperative and postoperative QRS interval in LBBP group was significantly less than that in RVP group(P < 0.01).(4)The results showed that the operation time of LBBP group was significantly longer than that of RVP group(P < 0.01).(5)The results showed that there was no significant difference in LVEF between RVP group and LBBP group(P > 0.05).One month after operation,LVEF value and preoperative and postoperative LVEF difference(postoperative preoperative)in RVP group were significantly less than those in LBBP group(P < 0.05).(6)The results showed that there was no significant difference in the threshold,perception and impedance of ventricular electrode between the two groups(P > 0.05).Conclusion:(1)The operation time of left bundle branch pacing was longer than that of right ventricular pacing,but there was no significant difference in the threshold,perception and impedance of ventricular electrodes between the two groups.Left bundle branch pacing was superior to right ventricular pacing in QRS interval,LVEF and rehospitalization rate.There was no significant difference in the incidence of adverse events such as ventricular electrode shedding and rehospitalization rate between the two groups.(2)There was no significant difference in short-term safety and incidence of adverse events between left bundle branch pacing and right ventricular pacing.In terms of short-term prognosis(improvement of postoperative cardiac function)and ventricular synchrony(narrow QRS interval),left bundle branch pacing was better than right ventricular pacing,and it was more physiological.In conclusion,left bundle branch pacing can be used as a safe and feasible scheme in patients with high degree of atrioventricular block. |
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