Fröhlig G
Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kirrberger Strasse, 66424, Homburg, Germany.
Herzschrittmacherther Elektrophysiol. 2008 Dec;19 Suppl 1:25-37. doi: 10.1007/s00399-008-0604-2.
Cardiac resynchronization therapy (CRT) using biventricular stimulation is hampered by coronary venous imponderabilities, complex implantation procedures, technical malfunctions and complications as well as disappointing responder rates. Despite its pathophysiological soundness and some initial success, the use of AV sequential pacing for the treatment of heart failure has been abandoned because right ventricular (RV) apical stimulation may be detrimental for cardiac mechanics, may worsen heart failure and may increase mortality. Attempts at avoiding desynchronizing effects and improving hemodynamics by pacing from alternative RV sites have been numerous but not convincing. Whether patients with left ventricular dysfunction or overt heart failure may benefit from pacing the RV outflow tract or septum, from dual site RV or His bundle stimulation instead of left ventricular based resynchronization is the topic of this review.
使用双心室刺激的心脏再同步治疗（CRT）受到冠状静脉情况不明、植入程序复杂、技术故障及并发症以及令人失望的反应率的阻碍。尽管房室顺序起搏在病理生理学上合理且取得了一些初步成功，但由于右心室心尖部刺激可能对心脏力学有害、可能使心力衰竭恶化并可能增加死亡率，其用于治疗心力衰竭已被放弃。通过从右心室其他部位起搏来避免失同步效应并改善血流动力学的尝试众多，但并不令人信服。左心室功能障碍或明显心力衰竭的患者是否可从右心室流出道或间隔起搏、双部位右心室起搏或希氏束刺激而非基于左心室的再同步治疗中获益，是本综述的主题。
