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束支传导阻滞与心肌梗死的关系以及对CRT的影响
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Abstract:
本文谨就束支传导阻滞(BBB)与心肌梗死的关系以及对心脏再同步治疗(CRT)的影响进行综述。前壁心肌梗死(AWMI)伴有右束支传导阻滞(RBBB)的心力衰竭(HF)患者缺血性心肌病(ICM)的检出率显著高于伴有左束支阻滞(LBBB)的患者，伴有RBBB的ICM患者大面积心肌瘢痕的检出率也显著高于LBBB患者，冠状动脉前降支(LAD)近端阻塞更多引起RBBB而不是LBBB，LBBB更容易由非ICM及左束支的硬化和纤维化所致。因ICM而植入CRT的LBBB患者死亡率显著降低，但RBBB患者的死亡率却显著增高，年增长率为10%，3年的联合终点事件增长50%；RBBB患者植入CRT后可引起左心室电激动不协调、机械收缩不同步、二尖瓣返流、肺动脉高压以及右心室功能不全等，预后不良死亡率增加。结论：AWMI后伴有RBBB的患者ICM的检出率及心肌瘢痕的面积均显著高于LBBB患者，冠状动脉前降支近端阻塞更易引起RBBB。伴有RBBB的HF患者植入CRT预后不良，故临床应权衡利弊慎重选择。
This article reviews the relationship between bundle branch block (BBB) and myocardial infarction and its impact on cardiac resynchronization therapy (CRT). The Prevalence of ischemic cardiomyopathy (ICM) in heart failure (HF) patients with right bundle branch block (RBBB) after anterior wall myocardial infarction (AWMI) was significantly higher than that of the patients with left bundle branch block (LBBB). The Prevalence of large myocardial scar in the RBBB patients was also significantly higher than that of patients with LBBB, anterior descending coronary artery (LAD) proximal occlusion causes more RBBB instead of LBBB. LBBB is more likely to be caused by sclerosis, fibrosis of the left bundle branch and non-ICM. The mortality of HF patients with LBBB patients that were implanted CRT was significantly reduced, but the mortality of RBBB patients was significantly increased, with an annual increase of 10% and a three-year joint endpoint events increase of 50%. RBBB patients implanted with CRT can cause left ventricular electrical disturbance, mechanical dyssynchrony, mitral regurgitation, pulmonary hypertension and right ventricular dysfunction, with a poor prognosis and increased mortality. Conclusion: The Prevalence of ICM and the area of myocardial scar in patients with RBBB after AWMI were significantly higher than those with LBBB, and the proximal occlusion of anterior descending coronary artery was more likely to cause RBBB. Heart failure patients with RBBB are associated with more severe RV dysfunction and a worse prognosis. All these variables have crucial value in assessing patients with RBBB for cardiac resynchronization therapy.
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