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Objective:Explore the characteristics of injury current changes in ventricular septal myocardium during left bundle branch area pacing (LBBAP) surgery.Methods:Retrospective analysis of clinical data of patients who underwent permanent pacemaker implantation at The Second People's Hospital of Wuxi in Jiangsu Province from January 2020 to November 2022. Among them, 42 patients were treated with LBBAP (LBBAP group) and 56 patients with Right ventricle septum pacing (RVSP group). Compare the conventional parameters such as threshold, perception, impedance during electrode implantation, damage current values at 0, 5, and 10 minutes before and after electrode rotation, and the correlation between damage current and conventional parameters. The measurement data is represented by xˉ± s, analysis of variance is used for comparison between multiple groups, t-test is used for comparison between two groups, and repeated measurement analysis of variance is used for comparison between two groups at multiple time points; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 Inspection; Pearson correlation analysis was used to analyze the correlation between the two variables. Results:There was no statistically significant difference in pacing threshold, perception, and impedance between the two groups of electrode implantation surgery (all P>0.05). The damage current values at 0, 5, and 10 minutes before and after electrode rotation in the LBBAP group were higher than those in the RVSP group [(7.19±1.26) mV compared to (5.33±0.79) mV, (22.50±3.06) mV compared to (10.85±1.70) mV, (15.75±2.63) mV compared to (8.01±1.09) mV, (9.24±2.00) mV compared to (5.51±0.98) mV]. The damage current values at 0 minutes after electrode rotation in both groups were higher than before electrode rotation, and gradually decreased thereafter, After 10 minutes of electrode placement, the damage current value of the LBBAP group was still higher than the level before electrode rotation (all P<0.05), while there was no statistically significant difference between the RVSP group and the level before electrode rotation ( P>0.05). The damage current value at 0 minutes after the LBBAP group electrode was in place was positively correlated with ventricular septal thickness and left ventricular posterior wall thickness ( r values 0.45 and 0.46, P values 0.003 and 0.002, respectively), and negatively correlated with conventional pacing parameter impedance ( r=-0.32, P=0.037). There was no correlation with threshold and perception ( r values 0.08 and 0.01, P values 0.604 and 0.968, respectively). The damage current value at 0 minutes after the RVSP group electrode was in place was negatively correlated with the threshold ( r=-0.28, P=0.036). Conclusions:The COI value of LBBAP interventricular septum myocardium increased significantly after the electrode was rotated out. The COI value at 0 min after the electrode put in place was positively correlated with the interventricular septum thickness and left ventricular posterior wall thickness, and negatively correlated with the electrode impedance, but there was no correlation with threshold and perception.
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Objective Respectively applying the treatment of biventricular pacing and right ventricular septal pacing in atrioventricular block,to compare the heart function influence of two kinds of pacing mode on pacemaker dependent patients, to provide evidence for the physiological pacing mode selection?Methods Enrolled 20 patients from January 2012 to March 2013 who should be placed in pacemakers, their primary disease was the second degree,high or third degree atrioventricular block,giving them three chamber pacemaker ( right atrial + biventricular ) each?Randomly divided into right ventricular septum pacing group ( group A, n=10) and biventricular pacing group( group B,n=10)?Twelve months later,each group crossed into the each other group and continued following?up for 12 months?After 24 months to obtain all the data to do the statistical analysis,including patients'6 min walking distance(6MWD),the Minnesota Heart Failure Quality of life score (MLHFQ),plasma N?terminal pro brain natriuretic peptide precursor(NT?proBNP),left ventricular ejection ejection fraction(LVEF),left ventricular diastolic end diastolic diameter(LVEDD),left ventricular contraction end diastolic diameter(LVESD),left ventricular twelve segmental 14W time standard deviation(Ts?12SD),left ventricular twelve segmental 14W time maximum delay(Ts?dif),the paced QRS qrsd?Results Compared with group B,the 6MWD and LVEF of 12,24 months after treatment of group A were significantly increased( ( 242?58 ±37?56) m vs?(347?42±36?59) m vs?(340?67±24?99) m;(39?97±5?84)% vs?(57?92±10?01)% vs?(60?50±10?06)%;P0?05)?Conclusion Compared with the right septal pacing,biventricular pacing is of no significant advantages on the effect of cardiac function for patients with pacemaker dependent.
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Objective To evaluate the effects of pacing in right ventricular septum (RVS) on hemodynamics among atrioventricular sequential dual chamber pacing Methods Twenty patients with high grade or complete atrioventricular block received permanent dual chamber pacemaker ( DDD ),were randomized into right ventricular septum pacing group (RVS)and right ventricular apex pacing group (RVA)according to the ventricular leads position.The QRS duration of the ECG,the left ventricular ejection (LVEF),the interventricular mechanical delay( IVMD )and the plasma levels of brain natriuretic peptide (BNP)were compared before and after operations.Results Compared with the preoperation,the mean QRS duration ( ( 187.00 ± 15.67 ) ms and (94.00 ±9.17 ) ms),the IV MD ( (43.20 ± 6.79 ) ms and ( 15.00 ± 4.08 ) ms ),the level of BNP ( ( 89.70 ± 8.30) ng/L and (40.00 ± 4.73 ) ng/L) increased( P ＜ 0.05 ) and LVEF decreased significantly ( (53.70 ± 1.34) % and (58.60 ±1.65 )% ,P ＜ 0.05 ) in RVA group,but didn't change in RVS group (P ＞ 0.05 ).After three months following up,the mean QRS duration and the IVMD in RVS group( (119.00 ±7.38 )ms,(19.00 ±4.59)ms) were shorter than that of RVA group( ( 187.00 ± 15.67) ms,(43.20 ± 6.79) ms) ( P ＜ 0.05 ),the LVEF was higher and the plasma level of BNP was lower than that of RVA group ( (57.00 ± 2.00) % and ( 53.70 ± 1.34) %,(44.20 ± 9.18 ) ng/Land ( 89.70 ±8.30) ng/L,P ＜0.05).Conclusions The RVS pacing could keep the normal ventricular activation sequence and biventricular contraction synchrony farthest without side effects on hemodynamics in comparison with the RVA pacing.The RVS pacing is more approaching physiological rhythm than the RVA pacing.
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Objective To investigate the feasibility and methodology of active fixation lead on patients under right ventricular outflow tract septum(RVOTS) pacing.Methods Fifty DDD pacemaker patients were enrolled 31 male,23 female,50~86 years old,mean age 67.7?8.6.Ventricular active fixation lead was implanted in the right ventricular apex(RVA) and RVOTS successively and pacing parameter was tested.Results The success rate of RVOTS active fixation lead implantation was 98.15%.Mean lead threshold was 0.73?0.12 V.Pacing QRS duration show a significant difference between RVOTS pacing and RVA pacing,130.45?18.24 and 153.11?20.10,respectively(P
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Objective To compare the cardiac function effect of right ventricular septum(RVS) pacing with that of right ventricular apex(RVA) pacing.Methods One hundred and six patients with indication of dual chamber pacemaker implantation were divide into two groups randomly.In each patient,influence of different pacing site to LVEF and pacing parameter were examined and left ventricular eject fractions were compared.Results All patients' operation were successful,LVEF of RVS group compared with that of RVA showed a significant difference.Conclusion The cardiac function are significantly different between right ventricular septum pacing group and right ventricular apex group.