Fröhlig G, Kindermann M
Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kirrbergerstrasse, 66424 Homburg, Germany.
Herzschrittmacherther Elektrophysiol. 2008 Mar;19(1):30-40. doi: 10.1007/s00399-008-0598-9.
The increasing evidence that right ventricular (RV) apical stimulation is detrimental for cardiac mechanics and increases the risk of new onset heart failure and mortality promotes strategies to avoid ventricular pacing and - if not applicable due to atrioventricular block - stipulates the search for alternative techniques of pacing the heart from the right ventricle. Despite more than 15 years of clinical research it remains unclear whether pacing from the right ventricular outflow tract or septum, dual site RV stimulation or selective pacing of the His bundle results in hemodynamic and prognostic benefit over the traditional method of apical RV pacing. The article reviews pertinent literature and tries to demonstrate pathophysiological mechanisms.
越来越多的证据表明，右心室心尖部刺激对心脏力学有害，并增加新发心力衰竭和死亡的风险，这促使人们采取策略避免心室起搏——如果因房室传导阻滞而无法避免，则规定寻找从右心室起搏心脏的替代技术。尽管经过了15年多的临床研究，但右心室流出道或间隔起搏、双部位右心室刺激或希氏束选择性起搏是否比传统的右心室心尖部起搏方法带来血流动力学和预后益处仍不清楚。本文回顾了相关文献，并试图阐述其病理生理机制。
