Prognostic Factors And Clinical Characteristics Of His-purkinje Conduction System Pacing Combined With Left Ventricular Pacing Hyperreaction In Patients With Chronic Heart Failure

Objective:To analyze the predictive factors and clinical features of hyperreaction in patients with chronic heart failure(CHF)after his-purkinje conduction system pacing combined with left ventricular pacing including his-optimized cardiac resynchronization therapy(HOT-CRT)and left bundle branch-optimized cardiac resynchronization therapy(LOT-CRT).Methods:Thirty CHF patients who received HOT-CRT/LOT-CRT in the second Department of Cardiology of Gansu Provincial People’s Hospital from May 2019 to May 2022 were selected as the study objects.According to left ventricular ejection fraction(LVEF)6 months after surgery,they were divided into hyperreaction group and non-hyperreaction group.The baseline and intraoperative clinical data differences between the two groups were compared.Multivariate logistic regression analysis was performed to obtain the predictive factors of hyperreaction after HOT-CRT/LOT-CRT.All patients were followed up for more than 6 months to compare the differences of postoperative optimized electrocardiogram and echocardiogram between the two groups,and then compared the differences of preoperative and postoperative optimized electrocardiogram and preoperative and postoperative echocardiogram 1 month and 6 month respectively between the two groups.In addition,the preoperative and postoperative clinical data changes(△preoperative minus postoperative)in the hyperreactive group and the non-hyperreactive group were calculated respectively and compared between the two groups.The improvement of postoperative cardiac function in two groups was obtained.Complications and re-hospitalization during follow-up were observed between the two groups,and Kaplan-Meier curve was plotted to compare the differences in all-cause mortality between the two groups.Results:1.In this study,the incidence of postoperative hyperreaction in 30 patients with CHF was 46.7%.Compared with the non-hyperreaction group,patients in the hyperreaction group had shorter hospital stay,smaller left atrial diameter(LAD)and lower pulmonary artery systolic blood pressure(PASP),with statistical significance(P<0.05),and the proportion of patients with diabetes was higher(P<0.05).Multivariate regression analysis showed that LAD(OR=0.822,95%CI:0.677～0.998,P=0.047)and PASP(OR=0.846,95%CI:0.721～0.994,P=0.042)were important predictors of hyperreaction after HOT-CRT/LOT-CRT.2.The comparison of postoperative clinical data between the two groups showed that in terms of postoperative optimization of electrocardiogram,the P-R interval in the hyperreaction group was shorter than that in the non-hyperreaction group(P<0.05).In terms of echocardiography at 6 months after surgery,compared with the non-hyperreactive group,the hyperreactive group had smaller right ventricular diameter(RVD),left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05),while higher LVEF and left ventricular short-axis shortening rate(LVFS)(P<0.001).3.The comparison of preoperative and postoperative clinical data between the two groups showed that,in terms of electrocardiogram,the postoperative P-R interval,QRS duration(QRSd)and QTc interval of patients in the hyperreaction group were significantly reduced compared with those before surgery(P<0.05),and the R-wave amplitude of V5 lead(RV5)was significantly increased compared with that before surgery(P<0.05).In the non-hyperreaction group,the postoperative QRSd were significantly reduced(P<0.05),while the RV5 was significantly increased(P<0.05).In terms of echocardiography,RVD,LVEDD and LVESD in the hyperreaction group were significantly reduced 1 month after surgery compared with those before surgery(P<0.05),while LVEF and LVFS were significantly increased compared with those before surgery(P<0.05).In addition to the above changes at the follow-up 6 months after surgery,The degree of mitral regurgitation(MR)was also significantly improved(P<0.05).The LAD,RVD and LVEDD in the non-hyperreaction group were significantly reduced 1 month after surgery(P<0.05),and the LVEF was significantly increased(P<0.05).At the follow-up 6 months after surgery,the LAD was significantly decreased(P<0.05),and the LVEF was significantly increased(P<0.05).RVD and LVEDD showed no significant changes compared with those before surgery(P>0.05).4.Comparing the preoperative and postoperative clinical data changes between the two groups,it was found that there was no significant difference between the two groups in terms of electrocardiogram changes(P>0.05).In terms of echocardiography,compared with the non-hyperreactive group,the △LVEDD and△LVESD were larger(P<0.05)and △LVEF and △LVFS were smaller(P<0.001)in the hyperreactive group at 6 months after surgery.That is,the improvement of cardiac function 6 months after operation in the hyperreaction group was more obvious than that in the non-hyperreaction group.5.Postoperative follow-up showed that there was no significant difference in postoperative complications and all-cause death between the two groups(P>0.05),while the re-hospitalization due to HF was significantly increased in the non-hyperreactive group compared with the hyperreactive group(P<0.05).Conclusion:LAD and PASP are important predictors of hyperreaction after HOT-CRT/LOT-CRT in CHF patients.The smaller LAD and lower PASP before surgery,the better the postoperative response.In addition,the improvement of cardiac function in patients with hyperreaction after surgery is better than that in patients without hyperreaction.