背景:左束支区域起搏(LBBAP)对右心室(RV)功能和三尖瓣反流(TR)的影响尚不清楚。
目的:我们旨在评估LBBAP对RV表现和TR的长期影响。
方法:使用RV自由壁应变(FWS)评估RV功能,三尖瓣环平面收缩期偏移(TAPSE),分数面积变化(FAC),和三尖瓣外侧环的收缩期(S')速度。使用反向间隔闪光(RSF)和基底隆起(BB)的存在来评估RV运动模式。测量了室间隔上的导线进入部位与三尖瓣环的间隔小叶之间的距离(导线-电视距离)。
结果:分析包括122名受试者(62名男性,年龄76.5±11.4岁),中位随访时间为21个月。随访期间,RVFWS明显改善(15.2±5.8vs16.4±5.5,p<0.001),而TAPSE,S',FAC保持不变。左心室射血分数是RV功能改善的独立预测因子(B:3.51,CI1.39-8.9,p=0.01)。有了LBBAP,22/23(96%)患者RSF消失,基线时存在RSF和BB的15/22(68%)患者和BB,分别。当基线存在RSF时,RV功能改善显著更高(14vs11例患者,p=0.02)。在后续行动中,全组TR无显著恶化.然而,导联-电视距离<24.5mm与TR进展相关.
结论:LBBAP对RV功能具有良好的影响。基础LBBAP位置与TR恶化相关。
BACKGROUND: The impact of left bundle branch area pacing (LBBAP) on right ventricular (RV) function and tricuspid regurgitation (TR) remains unclear.
OBJECTIVE: We aimed to assess the long-term effects of LBBAP on RV performance and on TR.
METHODS: RV function was evaluated using RV free wall strain, tricuspid annular plane systolic excursion, fractional area changing, and systolic velocity of the lateral tricuspid annulus. The presence of reverse septal flash (RSF) and basal bulge (BB) was used to assess RV motion pattern. The distance between the lead entry site on the interventricular septum and the septal leaflet of the tricuspid annulus (lead-TV distance) was measured.
RESULTS: The analysis included 122 subjects [62 men (50.8%); mean age 76.5 ± 11.4 years] with a median follow-up of 21 months (18-24.5 months). During follow-up, RV free wall strain improved significantly (15.2 ± 5.8 vs 16.4 ± 5.5; P < .001) while tricuspid annular plane systolic excursion, systolic, and fractional area changing remained unchanged. Left ventricular ejection fraction was an independent predictor of improved RV function (B = 3.51; 95% confidence interval 1.39-8.9; P = .01). With LBBAP, RSF disappeared in 22 of 23 patients (96%) and BB in 15 of 22 patients (68%) in whom RSF and BB were present at baseline, respectively. RV function improvement was significantly higher when RSF was present at baseline (14 patients vs 11 patients; P = .02). At follow-up, no significant deterioration in TR occurred for the overall group. However, a lead-TV distance of <24.5 mm was associated with TR progression.
CONCLUSIONS: LBBAP has a favorable impact on RV function. A basal LBBAP position is associated with worsening TR.