| Objective: This study compares left bundle branch area pacing(LBBAP)with traditional right ventricular apex pacing(Right ventricular apex pacing,RVAP)through echocardiogram(Ultrasound cardiogram,UCG)and 12-lead body surface electrocardiogram.)The influence of two pacing sites on cardiac structure,function and cardiac synchrony,to explore the short and mid-term safety of left bundle branch pacing in clinical application,and prove that left bundle branch pacing is more physiological.Methods: This study adopts a single-center,prospective,randomized controlled research method,and consecutively included patients who were successfully treated in the cardiology department of a tertiary hospital from June 2019 to May 2020 due to third-degree atrioventricular block(AVB).A total of 64 patients underwent permanent artificial cardiac pacemaker implantation,and the implanted pacemakers were all dual-chamber pacemakers.All patients were randomly divided into LBBAP group and RVAP group,of which 30 were in LBBAP group and 34 were in RVAP group.The QRS wave width,left ventricular end diastolic diameter,right ventricular end diastolic diameter,left atrial diameter,and left ventricular end diastolic diameter of the patient’s body surface were recorded before the operation.Ventricular ejection fraction,peak tricuspid regurgitation velocity,and the pre-ejection time difference between the main and pulmonary arteries,intraoperative recording of pacing parameters(unipolar pacing),total operation time,total X-ray exposure,1 week after surgery,Pacemaker program control and body surface ECG follow-up at 3 months,6 months and 12 months;echocardiography should be reviewed at 3 months,6 months,and 12 months postoperative follow-up,and QRS wave width and echocardiogram should be observed Changes in parameters,pacing parameters and the presence or absence of pacemaker-related complications.This study was conducted in accordance with the ethical guidelines of the Declaration of Helsinki in 1975,and all patients had signed written informed consent before enrollment.Results:1.All the selected patients successfully underwent LBBAP(30 cases)and RVAP(34cases).Among them,21 cases(32.8%)had a history of syncope(10 cases in the LBBAP group,11 cases in the RVAP group).Under the protection of Temporary cardiac pacemaker(TCP).In the LBBAP group,22 cases(73%)could record the left bundle branch potential(Po LBB)on intraoperative intracavitary electrograms.There was no statistically significant difference between the two groups of patients in general clinical baseline data(P>0.05).2.Comparison of QRS wave time limit:(1)Comparison between groups: LBBAP group and RVAP group(92.83 ± 10.36 vs 93.26 ± 10.26,P=0.868)ms before operation,the difference was not statistically significant;the average follow-up was11.93 ± 3.1 months,LBBAP group The pacing QRS wave time limit was significantly narrower than that of the RVAP group(94.33±7.63 vs 139.08±7.08,P=0.001)ms,with a significant difference.(2)Intra-group comparison: average follow-up 11.93±3.1 months,LBBAP the QRS pacing time limit(94.33±7.63)ms after the operation in the group had no significant change from the baseline(92.83±10.36)ms,and the difference was not statistically significant(P=0.584);the postoperative pacing QRS time limit in the RVAP group was(139.08±7.08))Ms was significantly longer than the preoperative(93.26±10.26)ms,and the difference was statistically significant(P=0.000).3.Comparison of cardiac function parameters:(1)Comparison between groups: The average follow-up was 11.93±3.1 months,the LVD of the LBBAP group did not increase compared with the RVAP group(40.50±5.17 vs 49.87±5.87,P=0.003)mm,the difference was statistically significant;RVAP The LVEF value of the LBBAP group was lower than that of the LBBAP group(0.55 ± 0.06 vs 0.66 ± 0.05,P=0.001)%,the difference was statistically significant;there was no significant change between the two groups before and after RVD,LA,and TRPV,and there was no statistical difference.Academic significance(P>0.05).(2)Intra-group comparison: The average follow-up was 11.93 ± 3.1 months.The postoperative cardiac function parameters(LVD,RVD,LA,LVEF,TRPV)of the LBBAP group had no significant changes compared with the preoperative ones,and the difference was not statistically significant(P>0.05);The LVEF value(0.55 ± 0.06)% of the RVAP group showed a downward trend compared with the baseline(0.61±0.06)%,and the difference was statistically significant(P<0.05).The postoperative LVD(49.87 ± 5.87)mm of the RVAP group was higher than that of the preoperative(43.83).±4.47)mm increased,and the difference was statistically significant(P<0.05).Postoperative LA(30.10±4.75)mm increased compared with preoperative(25.21 ± 4.53)mm,and the difference was statistically significant(P < 0.05).However,there were no significant changes before and after RVD and TRPV,and the difference was not statistically significant(P>0.05).4.Comparison of inter-chamber synchronization:(1)Comparison between groups:The average follow-up was 11.93±3.1 months,and the IVMD comparison between the two groups(LBBAP group vs RVAP group 29.13±12.62 vs 41.79±18.30)ms,there was a significant difference(P=0.000).(2)Intra-group comparison: The average follow-up was 11.93±3.1 months.Compared with the preoperative IVMD,the IVMD of the LBBAP group remained stable(29.13±12.62 vs 30.03±7.22)ms,the difference was not statistically significant(P>0.05);the IVMD of the RVAP group was compared with the operation Before the increase(41.79±18.30 vs 27.17±10.54)ms,the difference was statistically significant(P<0.05).5.The average follow-up was 11.93±3.1 months.The pacing ventricular perception,impedance and capture threshold of the two groups remained good and stable,and there was no statistical difference(P>0.05).There was no pneumothorax or capsular infection in the two groups during the entire follow-up period.,Electrode dislocation,myocardial perforation and other pacing-related complications.6.The total operation time and total X-ray exposure of patients in the LBBAP group were longer than those in the RVAP group(P < 0.05),the difference was statistically significant.Conclusion:LBBAP is superior to RVAP in maintaining good electro-mechanical synchronization of the heart.It is good for protecting the structure and function of the heart.With good pacing parameters,it is an ideal and safe physiological pacing method. |
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