Three-dimensional electroanatomical mapping guidelines for the selection of pacing site to achieve cardiac resynchronization therapy.
Three-dimensional electroanatomical mapping guidelines for the selection of pacing site to achieve cardiac resynchronization therapy.
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DOI：
10.3389/fcvm.2022.843969
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发表时间：
2022
影响因子：
3.6
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中科院分区：
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我们的目的是评估左心室电解剖测绘在左束分支区起搏（LBBAP）和冠状静脉起搏（CVP）之间选择的可行性。在心脏再同步化治疗（CRT）中，实现左心室激活的方法有几种：LBBAP和CVP是两种可能的传递CRT的方法。然而，选择最佳方法的标准仍然未知。共招募心力衰竭、射血分数降低、左束支阻滞（LBBB）患者71例，其中38例行左心室三维电解剖作图，准确评估左束支是否阻滞及阻滞程度，其余33例未作图。真性LBBB患者通过LBBAP达到CRT，假性LBBB患者通过CVP达到CRT。在平均随访6个月和1年后，评估QRS持续时间和经胸超声心动图，包括机械同步指数。25例真LBBB患者接受LBBAP治疗，13例非真LBBB患者接受CVP治疗。17例患者接受LBBAP治疗，16例患者接受CVP治疗。定位亚组植入LBBAP和CVP后的QRS节律持续时间明显短于非定位亚组。LBBAP或CVP患者植入后左室射血分数显著升高，且定位亚组优于非定位亚组。经过12个月的随访，在LBBAP和CVP方面，与非定位组相比，定位亚组的房室、室内和双室同步性均有显著改善。在我们的研究中，采用三维电解剖作图的方法选择LBBAP或CVP治疗心力衰竭患者，经长期随访证明是可行的，心脏再同步化效果较好。因此，CRT前的三维电解剖制图似乎是一种可靠的方法，心力衰竭伴有LBBB的患者谁指征CRT。本研究表明，三维电解剖制图具有较好的心脏再同步性，为心力衰竭患者选择LBBAP或CVP提供了知情指导。
We aimed to evaluate the feasibility of left ventricular electroanatomical mapping to choose between left bundle branch area pacing (LBBAP) or coronary venous pacing (CVP). There are several ways to achieve left ventricular activation in cardiac resynchronization therapy (CRT): LBBAP and CVP are two possible methods of delivering CRT. However, the criteria for choosing the best approach remains unknown. A total of 71 patients with heart failure, reduced ejection fraction, and left bundle branch block (LBBB) were recruited, of which 38 patients underwent the three-dimensional electroanatomical mapping of the left ventricle to accurately assess whether the left bundle branch was blocked and the block level, while the remaining 33 patients were not mapped. Patients with true LBBB achieved CRT by LBBAP, while patients with pseudo-LBBB achieved CRT by CVP. After a mean follow-up of 6 months and 1 year, the QRS duration and transthoracic echocardiography, including mechanical synchrony indices, were evaluated. Twenty-five patients with true LBBB received LBBAP, while 13 without true LBBB received CVP. Seventeen patients received LBBAP, and 16 patients received CVP without mapping. Paced QRS duration after the implantation of LBBAP and CVP was significantly narrower in the mapping subgroup compared to the non-mapping subgroup. A significant increase in post-implantation left ventricular ejection fraction was observed in patients with LBBAP or CVP, and the mapping subgroup were better than the non-mapping subgroup. After a 12-month follow-up, atrioventricular, intraventricular, and biventricular synchronization were significantly improved in the mapping subgroup compared to non-mapping groups in both LBBAP and CVP. In our study, three-dimensional electroanatomical mapping was used to choose LBBAP or CVP for heart failure patients, which proved feasible, with better cardiac resynchronization in the long-term follow-up. Therefore, three-dimensional electroanatomical mapping before CRT appears to be a reliable method for heart failure patients with LBBB who are indicated for CRT. This study shows that three-dimensional electroanatomical mapping, with better cardiac resynchronization, provides informed guidance to choose between LBBAP or CVP for patients with heart failure.
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