Mond Harry G
Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
Pacing Clin Electrophysiol. 2010 Jul;33(7):888-98. doi: 10.1111/j.1540-8159.2010.02777.x. Epub 2010 Apr 26.
Prolonged right ventricular (RV) apical pacing is associated with progressive left ventricular dysfunction due to dysynchronous ventricular activation and contraction. RV septal pacing allows a narrower QRS compared to RV apical pacing, which might reflect a more physiological and synchronous ventricular activation. Previous clinical studies, which did not consistently achieve RV septal pacing, were not confirmatory and need to be repeated. This review summarizes the anatomy of the RV septum, the radiographic appearances of pacing leads in the RV, the electrocardiograph correlates of RV septal lead positioning, and the techniques and tools required for implantation of an active-fixation lead onto the RV septum. Using the described techniques and tools, conventional active-fixation leads can now be reliably secured to either the RV outflow tract septum or mid-RV septum with very low complication rates and good long-term performance. Even though physiologic and hemodynamic studies on true RV septal pacing have not been completed, the detrimental effects of long-term RV apical pacing are significant enough to suggest that it is now time to leave the RV apex and secure all RV leads onto the septum.
由于心室激活和收缩不同步，右心室（RV）心尖部长期起搏与进行性左心室功能障碍相关。与RV心尖部起搏相比，RV间隔起搏可使QRS波更窄，这可能反映了更生理性和同步性的心室激活。以往的临床研究未能始终实现RV间隔起搏，结果不具确定性，需要重复进行。本综述总结了RV间隔的解剖结构、RV起搏导线的影像学表现、RV间隔导线定位的心电图相关性，以及将主动固定导线植入RV间隔所需的技术和工具。使用所述技术和工具，现在可以将传统的主动固定导线可靠地固定在RV流出道间隔或RV间隔中部，并发症发生率非常低，长期性能良好。尽管关于真正的RV间隔起搏的生理和血流动力学研究尚未完成，但长期RV心尖部起搏的有害影响已足够显著，表明现在是时候离开RV心尖部，将所有RV导线固定在间隔上了。
