| Objective:The purpose of this study was to compare the short-term functional changes of left atrium and right ventricle after left bundle branch pacing and right ventricular septal pacing in patients with third degree atrioventricular block.Methods:This study is a single-center prospective cohort study,involving 28 patients who were diagnosed with third degree atrioventricular block and successfully implanted pacemaker in the Department of Cardiology of Shengjing Hospital affiliated to China Medical University from May to November 2022.They were divided into LBBP group(18 cases)and RVSP group(10 cases)according to the location of ventricular lead implantation.All patients were tested with blood cell analysis,liver function,renal function,Pro-BNP and other biochemical indexes on the day of admission or in the morning of the next day.ECG before,immediately after and 3 months after operation was performed.Echocardiographic images of patients before and 3 months after operation were detected with two-dimensional spot tracking imaging(2D-STI)technology.Immediate pacing parameters during operation were recorded.Pacing parameters and related complications were followed up 3 months after operation in both groups.Results:A total of 28 patients were included in this study,including 18 patients in LBBP group,with an average age of(70.61 ± 9.21)years.There were 10 cases in RVSP group,with an average age of(73.70 ± 10.81)years.There was no significant difference in baseline data between the two groups(P>0.05).The R wave amplitude of patients in LBBP group during pacemaker implantation was lower than that in RVSP group [(8.23 ± 2.10)m V vs(12.40 ± 4.22)m V,P<0.05].There was no statistically significant difference in the R wave amplitude between the two groups 3months after implantation(P>0.05).The threshold and impedance of the two groups were stable,and the difference was not statistically significant(P>0.05).The QRS wave in RVSP group was significantly wider than that in LBBP group immediately[(130.10 ± 24.91)ms vs(106.83 ± 8.60)ms,P<0.05] and 3 months [(128.30 ± 20.93)ms vs(109.44 ± 8.23)ms,P<0.05] after operation.The comparison of echocardiographic parameters showed that the left ventricular related left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and left ventricular global longitudinal strain(LVGLS)of the two groups remained stable before and 3 months after operation,the difference was not statistically significant(P>0.05).At 3 months after operation,the left atrial storage strain in LBBP group was higher than that in RVSP group [(36.96 ± 1.84)% vs(33.24 ± 4.61)%,P<0.05],and the global longitudinal strain of the right ventricle(RVGLS)was higher than that in RVSP group [(21.88 ± 1.39)% vs(20.13 ± 2.18)%,P<0.05].Intra-group comparison showed that there were no statistically significant differences in left atrial strain(storage strain,pipeline strain and pump strain),the global longitudinal strain of the right ventricle(RVGLS),the fractional area change of the right ventricle(RV-FAC),and tricuspid annular systolic peak velocity(s’)between LBBP group and those before operation(P>0.05).In the RVSP group,the left atrial storage strain [(33.24 ± 4.61)%vs(36.24 ± 5.74)%,P<0.05],left atrial pump strain [(14.05 ± 4.59)% vs(16.67 ±3.40)%,P<0.05] and RVGLS [(20.13 ± 2.18)% vs(21.90 ± 1.65)%,P<0.05] were lower than those before operation.Pacemaker implantation was successfully performed in all patients,and there were no ventricular septal perforation,lead displacement,bag infection and other events during the operation and follow-up.Conclusion:LBBP,as a new physiological pacing method,has more advantages than RVSP in maintaining the electrical and mechanical synchronization of left atrium and right ventricle in patients with third-degree atrioventricular block in the near future. |
PDF Full Text Request