Padeletti Luigi, Lieberman Randy, Valsecchi Sergio, Hettrick Douglas A
Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy.
Pacing Clin Electrophysiol. 2006 Dec;29 Suppl 2:S73-7. doi: 10.1111/j.1540-8159.2006.00493.x.
Right ventricular (RV) apical pacing impairs left ventricular function by inducing dys-synchronous contraction and relaxation. Chronic RV apical pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. These observations have raised questions regarding the appropriate pacing mode and site, leading to the introduction of algorithms and new pacing modes to reduce the ventricular pacing burden in dual chamber devices, and a shift of the pacing site away from the RV apex. However, further investigations are required to assess the long-term results of pacing from alternative sites in the right ventricle, because long-term results so far are equivocal. The potential benefit of prophylactic biventricular, mono-chamber left ventricular, and bifocal RV pacing should be explored in selected patients with a narrow QRS complex, especially those with impaired left ventricular function. His bundle pacing is a promising and evolving technique that requires improvements in lead technology.
右心室心尖部起搏通过诱发不同步收缩和舒张损害左心室功能。慢性右心室心尖部起搏与心房颤动、发病率甚至死亡率增加的风险相关。这些观察结果引发了关于合适的起搏模式和部位的问题，从而促使引入算法和新的起搏模式以减少双腔装置中的心室起搏负担，并使起搏部位从右心室心尖部转移。然而，需要进一步研究来评估右心室其他部位起搏的长期结果，因为目前的长期结果尚无定论。对于QRS波群狭窄的特定患者，尤其是左心室功能受损的患者，应探索预防性双心室起搏、单腔左心室起搏和双焦点右心室起搏的潜在益处。希氏束起搏是一项有前景且不断发展的技术，需要改进导线技术。
