<br>用于感测植入式心律转复除颤器中室性心律失常的左束支起搏导线：一项试点研究（LBBP-ICD 研究）,Heart Rhythm

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用于感测植入式心律转复除颤器中室性心律失常的左束支起搏导线：一项试点研究（LBBP-ICD 研究）
Heart Rhythm ( IF 5.6 ) Pub Date : 2023-12-22 , DOI: 10.1016/j.hrthm.2023.12.009
Shunmuga Sundaram Ponnusamy ₁ , Vadivelu Ramalingam ₁ , Selvaganesh Mariappan ₁ , Vithiya Ganesan ₂ , Vijesh Anand ₁ , Thabish Syed ₁ , Senthil Murugan ₁ , Mahesh Kumar ₁ , Pugazhendhi Vijayaraman ₃

Affiliation

左束支起搏（LBBP）已被建议作为符合心脏再同步治疗（CRT）资格的患者双心室起搏的替代方式。由于 LBBP 提供稳定的 R 波传感，最近已被用于为接受植入式心律转复除颤器 (ICD) 和 CRT 的患者提供室性心律失常的传感。本研究的目的是分析 LBBP 导联的长期安全性和有效性，以适当检测室性心律失常并为需要 CRT 除颤治疗的患者提供抗心动过速起搏 (ATP)。成功接受 LBBP 优化 ICD 和 LBBP 优化带除颤器 CRT 的符合 CRT 条件的患者被纳入。盖住 DF-1–ICD 导线的 IS-1 连接器插头后，将 LBBP 导线连接至右心室 -P/S 端口。根据传导系统疾病的矫正情况决定LBBP优化ICD或LBBP优化加除颤器CRT。分析记录的心律失常发作和实施的治疗。共招募了 30 名患者。平均年龄为 59.7 ± 10.5 岁。 LBBP 导致左心室射血分数从 29.9% ± 4.6% 增加至 43.9% ± 11.2% ( < .0001)。在平均 22.9 ± 12.5 个月的随访期间，记录了 254 起室性心律失常事件。适当事件 (n = 225 [89%]) 包括非持续性室性心动过速 (VT) (n = 212 次发作 [94%])、VT (n = 8 [3.5%]) 和心室颤动 (n = 5 [2.5%]) ]）。 ATP 终止 VT 的效率为 75%。由于 T 波过度感应，11% 的事件 (n = 29) 被错误地检测到。进行了 14 次不适当治疗 (ATP)（5.5%）。三名患者（10%）三尖瓣反流恶化。通过 LBBP 导线进行心律失常检测是安全的，因为约 90% 的心律失常都能被正确检测到。未来对专用 LBBP 除颤器导线以及避免过度感测的算法的研究有助于将除颤与传导系统起搏相结合。

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Left bundle branch pacing lead for sensing ventricular arrhythmias in implantable cardioverter-defibrillator: A pilot study (LBBP-ICD study)

Left bundle branch pacing (LBBP) has been suggested as an alternative modality for biventricular pacing in cardiac resynchronization therapy (CRT)–eligible patients. As it provides stable R-wave sensing, LBBP has been recently used to provide sensing of ventricular arrhythmia in patients receiving implantable cardioverter-defibrillator (ICD) with CRT. The aim of this study was to analyze the long-term safety and efficacy of the LBBP lead for appropriate detection of ventricular arrhythmia and delivery of antitachycardia pacing (ATP) in patients requiring defibrillator therapy with CRT. CRT-eligible patients who underwent successful LBBP-optimized ICD and LBBP-optimized CRT with defibrillator were enrolled. The LBBP lead was connected to the right ventricular-P/S port after capping the IS-1 connector plug of the DF-1–ICD lead. LBBP-optimized ICD or LBBP-optimized CRT with defibrillator was decided on the basis of correction of conduction system disease. Documented arrhythmic episodes and therapy delivered were analyzed. Thirty patients were enrolled. The mean age was 59.7 ± 10.5 years. LBBP resulted in an increase in left ventricular ejection fraction from 29.9% ± 4.6% to 43.9% ± 11.2% ( < .0001). During a mean follow-up of 22.9 ± 12.5 months, 254 ventricular arrhythmic events were documented. Appropriate events (n = 225 [89%]) included nonsustained ventricular tachycardia (VT) (n = 212 episodes [94%]), VT (n = 8 [3.5%]), and ventricular fibrillation (n = 5 [2.5%]). ATP efficacy in terminating VT was 75%. Eleven percent of episodes (n = 29) were inappropriately detected because of T-wave oversensing. Inappropriate therapy (ATP) was delivered for 14 episodes (5.5%). Three patients (10%) had worsening of tricuspid regurgitation. Sensing from the LBBP lead for arrhythmia detection is safe as ∼90% of the episodes were detected appropriately. Future studies with a dedicated LBBP-defibrillator lead along with algorithms to avoid oversensing can help in combining defibrillation with conduction system pacing.

更新日期：2023-12-22

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