Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.
Arq Bras Cardiol. 2011 Jan;96(1):76-85.
The conventional right ventricular stimulation can be associated with deleterious effects on cardiac function. The need for a more physiological artificial cardiac stimulation is undoubtedly one of the most important points in the area of cardiac electrotherapy. The programming algorithms for the maintenance of adequate atrioventricular conduction, the stimulation of alternative endocardial sites and the cardiac resynchronization therapy are used with the objective of attaining these goals. The stimulation of the bundle of His and the septal stimulation have been studied as alternative endocardial sites for the positioning of the electrode on the right ventricle. The septal stimulation represents a simple and practical alternative, with no additional costs involved and with potential benefits in decreasing the deleterious effects of the right ventricular stimulation. However, this alternative site involves a heterogeneous group of patients and presents conflicting results regarding its long-term clinical benefit. This article reviews the scientific evidence on the alternative sites for right ventricular stimulation, with emphasis on the safety of the procedure, the measurement of the electrophysiological parameters, assessment of the left ventricular function and the clinical follow-up of patients.
传统的右心室刺激可能对心脏功能产生有害影响。更生理性的人工心脏刺激的需求无疑是心脏电疗领域最重要的要点之一。维持充分的房室传导、刺激替代心内膜部位和心脏再同步治疗的编程算法被用于实现这些目标。希氏束刺激和间隔刺激已被研究作为替代心内膜部位，用于在右心室放置电极。间隔刺激是一种简单实用的替代方法，没有额外的费用，并且具有减少右心室刺激的有害影响的潜在益处。然而，这种替代部位涉及到一组异质的患者，并且关于其长期临床益处的结果存在冲突。本文回顾了关于右心室刺激替代部位的科学证据，重点关注程序的安全性、电生理参数的测量、左心室功能的评估和患者的临床随访。
