在心衰模型中进行有或无传导系统捕获的左束支区起搏

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2024-10-01 DOI:10.1016/j.jacep.2024.05.007

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引用次数: 0

摘要

背景：左束支区起搏包括左束支起搏（LBBP）和左室间隔起搏（LVSP），对非同步性心力衰竭（DHF）患者有效。然而，其基本机制尚不清楚：本研究旨在比较 LBBP 和 LVSP，并探索 LBBP 临床疗效更好的潜在机制：共将 24 只猎兔犬分为以下几组：1）对照组；2）DHF 组，左束支消融术后以 200 ppm 进行为期 6 周的 AOO 起搏；3）LBBP 组，DHF 3 周后以 200 ppm 进行为期 3 周的 DOO 起搏；4）LVSP，LBBP 组采取相同的干预措施。对心电图、超声心动图、血液动力学和左心室蛋白表达等指标进行了评估：结果：与 LVSP 相比，LBBP 的峰值应变弥散（44.67 ± 1.75 ms vs 55.50 ± 4.85 ms; P < 0.001）和血流动力学效果（dP/dtmax 改善：27.16% ± 7.79% vs 11.37% ± 4.73%; P < 0.001）更好，而心功能无显著差异。LBBP和LVSP可部分逆转DHF组侧壁与室间隔蛋白质表达的改变，这分别与收缩和粘附过程有关：动物研究表明，LBBP比LVSP能提供更好的机械同步性和改善血液动力学，这可能与收缩蛋白的逆转表达有关。这些结果支持了左束支区起搏在 DHF 模型中捕捉传导系统的潜在优势。

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Left Bundle Branch Area Pacing With or Without Conduction System Capture in Heart Failure Models

Background

Left bundle branch area pacing includes left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP), which is effective in patients with dyssynchronous heart failure (DHF). However, the basic mechanisms are unknown.

Objectives

This study aimed to compare LBBP with LVSP and explore potential mechanisms underlying the better clinical outcomes of LBBP.

Methods

A total of 24 beagles were assigned to the following groups: 1) control group; 2) DHF group, left bundle branch ablation followed by 6 weeks of AOO pacing at 200 ppm; 3) LBBP group, DHF for 3 weeks followed by 3 weeks of DOO pacing at 200 ppm; and 4) LVSP with the same interventions in the LBBP group. Metrics of electrocardiogram, echocardiography, hemodynamics, and expression of left ventricular proteins were evaluated.

Results

Compared with LVSP, LBBP had better peak strain dispersion (44.67 ± 1.75 ms vs 55.50 ± 4.85 ms; P < 0.001) and hemodynamic effect (dP/dtmax improvement: 27.16% ± 7.79% vs 11.37% ± 4.73%; P < 0.001), whereas no significant differences in cardiac function were shown. The altered expressions of proteins in the lateral wall vs septum in the DHF group were partially reversed by LBBP and LVSP, which was associated with the contraction and adhesion process, separately.

Conclusions

The animal study demonstrated that LBBP offered better mechanical synchrony and improved hemodynamics than LVSP, which might be explained by the reversed expression of contraction proteins. These results supported the potential superiority of left bundle branch area pacing with the capture of the conduction system in DHF model.

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.