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中华心脏与心律电子杂志 ›› 2025, Vol. 13 ›› Issue (04) : 250 -252. doi: 10.3877/cma.j.issn.2095-6568.2025.04.009

病例报告

无创血流动力学监测指导左束支起搏优化心脏再同步治疗一例
苏艳玲1,2, 禹子清1, 梁义秀1,()   
  1. 1200032 上海,复旦大学附属中山医院心内科 复旦大学附属闵行医院 上海市心血管病研究所 国家放射与治疗临床医学研究中心
    2201100 上海,复旦大学附属闵行医院心内科
  • 收稿日期:2025-03-17 出版日期:2025-12-25
  • 通信作者: 梁义秀

Optimization of cardiac resynchronization therapy through left bundle branch pacing guided by non-invasive hemodynamic monitoring: a case report and technical exploration

Yanling Su1,2, Ziqing Yu1, Yixiu Liang1,()   

  1. 1Department of Cardiology, Zhongshan Hospital of Fudan University, Minhang Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
    2Department of Cardiology, Minhang Hospital of Fudan University, Shanghai 201100, China
  • Received:2025-03-17 Published:2025-12-25
  • Corresponding author: Yixiu Liang
引用本文:

苏艳玲, 禹子清, 梁义秀. 无创血流动力学监测指导左束支起搏优化心脏再同步治疗一例[J/OL]. 中华心脏与心律电子杂志, 2025, 13(04): 250-252.

Yanling Su, Ziqing Yu, Yixiu Liang. Optimization of cardiac resynchronization therapy through left bundle branch pacing guided by non-invasive hemodynamic monitoring: a case report and technical exploration[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2025, 13(04): 250-252.

无创血流监测通过优化房室延迟(AVD)提升心脏再同步治疗(CRT)效果,但在左束支起搏(LBBP)中应用罕见。本文报道1例扩张型心肌病伴完全性左束支传导阻滞患者行LBBP,术中以无创血流监测收缩压变化,按最大增幅优化AVD(160 ms)。术后3个月左心室射血分数由35%升至55%。本例为LBBP-CRT参数优化提供新思路,还需大样本验证其价值。

图1 双心室起搏和左束支起搏调整房室延迟过程中心电图及血流动力学变化示例(针对每个房室延迟计算平均值和可信区间,并对不同房室延迟下多次转换的数据进行二次曲线拟合,以获得双心室起搏和左束支起搏下收缩压峰值增量;△及其连接线表示血流动力学最佳状态及相应房室延迟;▽及其连接虚线表示具有最短QRS时限的血流动力学状态及相应房室延迟)
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