Butter C, Auricchio A, Stellbrink C, Schlegl M, Fleck E, Hörsch W, Huvelle E, Ding J, Kramer A
Charité, Campus Virchow, Humboldt-University and German Heart Institute, Berlin, Germany.
Am J Cardiol. 2000 Nov 2;86(9A):144K-151K. doi: 10.1016/s0002-9149(00)01385-0.
Right ventricular pacing at various sites and shortened atrioventricular (AV) delay has failed to demonstrate a convincing short-term and long-term improvement of left ventricular function. Left-ventricular-based stimulation offers a new therapeutic option for patients with symptomatic congestive heart failure and conduction disturbances, especially of left bundle-branch block configuration. Left ventricular mechanical improvement seems mainly dependent on the pacing site, in addition to optimizing the AV delay. Predominantly retrospective data suggest that pacing the posterolateral free wall results in the greatest hemodynamic improvement. Based on the evaluation of different pacing sites in 2 patients, we noted that site is of major importance for maximal improvement of left ventricular function, and pacing at a suboptimal site can even deteriorate left ventricular contractility. Moreover, lead technology has advanced rapidly and different areas of the left ventricle can now be reached transvenously for acute and chronic placement. Therefore, ongoing trials will help to identify the optimal pacing site and might indicate whether invasive testing will be required in the future.
在不同部位进行右心室起搏以及缩短房室（AV）延迟，均未能显示出左心室功能在短期和长期内有令人信服的改善。基于左心室的刺激为有症状的充血性心力衰竭和传导障碍患者，尤其是左束支传导阻滞形态的患者提供了一种新的治疗选择。除了优化房室延迟外，左心室机械功能的改善似乎主要取决于起搏部位。主要的回顾性数据表明，在后外侧游离壁进行起搏可带来最大的血流动力学改善。基于对2例患者不同起搏部位的评估，我们注意到部位对于左心室功能的最大改善至关重要，在非最佳部位起搏甚至可能使左心室收缩力恶化。此外，导联技术发展迅速，现在可以通过静脉途径到达左心室的不同区域进行急性和慢性植入。因此，正在进行的试验将有助于确定最佳起搏部位，并可能表明未来是否需要进行侵入性检查。
