Assessment Of The Efficacy Of Real-time Three-dimensional Echocardiography And Two-dimensional Speckle Tracking Imaging In Patients With His-bundle Pacing

Objective: To assess the efficacy of his bundle pacing in patients with high-grade atrioventricular block and patients with heart failure using real-time threedimensional echocardiography and two-dimensional speckle tracking imaging.Methods: Our study included 30 patients with high-grade atrioventricular block and 21 patients with heart failure who received the HBP lead between 2016 and 2019.Inclusion criteria were:(1)age > 7 years;(2)written informed consent for the study;(3)ultrasound examination before surgery.Exclusion criteria were:(1)Severe arrhythmia(frequent premature beats,etc.)affect ultrasound image acquisition;(2)poor ultrasound sound transmission conditions;(3)expected survival time < 12 months;(4)myocardial ischemia found during noninvasive examination,suggesting coronary heart disease;(5)previous history of myocardial infarction or myocarditis;(6)organic(degenerative or rheumatic)valvular disease without treatment.The patients with HBP had transthoracic echocardiographic measurements prior to device implantation.Routine cardiac function parameters,2D STI and RT 3DE parameters were measured in all patients among 3 months,6 months and 12 months of follow-up after implantation.The left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular stroke volume(LVSV),left ventricular ejection fraction(LVEF)and Tmsv SD%,Tmsv Dif% were measured using real-time three-dimensional echocardiography(RT 3DE).GLS and GCS were obtained using a software for two-dimensional speckle tracking imaging(2D STI).Inter-group comparisons were performed.Results:(1)In the patients with high-grade atrioventricular block who received the HBP lead,there were no significant differences in GCS,GLS,LVEDV,LVESV,LVEF,16-12 Tmsv SD%、16-12 Tmsv Dif% between before implantation and follow-up after implantation(all p> 0.05).(2)In the patients with heart failure who received the HBP lead,compared with pre-operation,GCS,GLS,LVEDV,LVESV,16-12 Tmsv SD%、16-12 Tmsv Dif% were all significantly reduced(P<0.05),while LVEF was higher(P<0.05)at 3 months of follow-up after implantation.Compared with 3 months of follow-up after implantation,GCS,GLS,LVEDV,LVESV,16-12 Tmsv SD%,16-12 Tmsv Dif% were all significantly reduced(P<0.05),while LVEF was higher(P<0.05)at 6 months of follow-up after implantation.Compared with 6 months of follow up after implantation,GCS,GLS,LVEDV,LVESV,16-12 Tmsv SD%,16-12 Tmsv Dif% were all significantly reduced(P<0.05),while LVEF was higher(P<0.05)at 12 months of follow-up after implantation.Conclusion:(1)It is proved by real-time three-dimensional echocardiography and twodimensional speckle tracking imaging that patients with heart failure treated by His bundle pacing have better improvement in postoperative left ventricular systolic function and synchrony.(2)The time-volume curve of real-time threedimensional echocardiography is a sensitive index for evaluating the synchrony of left ventricular myocardial synchronization.(3)GLS and GCS of twodimensional speckle tracking technology are reliable indicators for evaluating left ventricular systolic function.(4)Real-time three-dimensional echocardiography and two-dimensional speckle tracking technology can evaluate the postoperative efficacy of His bundle pacing patients in an objective,accurate,non-invasive and timely manner.