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目的 寻找His束起搏(His-bundle pacing,HBP)用于心脏再同步化起搏和除颤治疗(CRT或CRT-D)更好的起搏和感知配置,从而改善HBP用于CRT-D患者治疗的安全性.方法 16例成功植入His束起搏导线的CRT-D患者在术中和术后即刻、1个月随访时通过改变起搏及感知配置,测量组合双极[HBP tip(Left Ventricular-tip,LV-tip)-RV-coil(Right Ventricular-coil)]与传统双极[HBPtip(LV-tip)—HBP-ring(LV-ring)]时的R波感知振幅、阈值及阻抗并通过公式计算HBP消除CLBBB阈值输出时(脉宽为0.5 ms)的输出能量、导线电流和导线电流密度.结果 在术中和术后即刻、1个月随访时,组合双极的感知幅度高于传统双极(P＜0.05),阻抗、阈值均低于传统双极(P＜0.05);组合双极在术中输出能量低于传统双极;术后即刻和1个月时无差异(P＞0.05).术后1个月随访两种配置的阈值与术中比较保持稳定(P＞0.05).结论 当HBP应用在CRT-D治疗时,通过改变不同的HBP(LV)起搏/感知配置发现组合双极比传统双极表现出更高的R波感知振幅,更低的起搏阈值和阻抗,并且不增加能量消耗.“,”Objective By changing the pacing/sensing configurations in permanent His-bundle pacing(HBP) patients with CRT-D implantation,the electrode thresholds and sensing parameters of HBP could be optimized to improve the stability and safety of HBP.Methods Sixteen patients were implanted CRT-D by permanent HBP mode,the pacing and sensing configurations were changed and R wave sensing amplitude,pacing threshold and impedance parameters were measured in integrated bipolar mode (HBP,LV-tip-RV-coil) and ture bipolar mode (HBP,LV-tip-LV-ring) during,immediately and one month after operation.Pacing energy,current drain and current drain density at the threshold output were calculated by formulae.Results In intra and post-operation the sensing parameters of integrated bipolar configuration was higher than that of the true bipolar configuration(P＜0.05).The impedance and threshold (at a pulse width of 0.5 ms) of the integrated bipolar configuration were lower than true bipolar configuration (P＜0.05) during and after implant.The thresholds of two kept stable at 1-month follow-up (P＞0.05).Energy expenditure of integrated bipolar was lower than that of true bipolar configuration during implant.No statistical difference with energy expenditure was found between the two pacing configurations.Conclusions By changing the different pacing/sensing configurations of HBP electrode,integrated bipolar configuration performs better sensing,lower threshold and impendence.And it has also no more energy expenditure than true bipolar configuration.