United Heart and Vascular Clinic, 225 N. Smith Ave. #400, St. Paul, MN 55102, USA.
J Cardiovasc Transl Res. 2012 Apr;5(2):219-31. doi: 10.1007/s12265-011-9341-8. Epub 2011 Dec 22.
Cardiac pacing is a common treatment option for patients with sick sinus syndrome or atrioventricular block, with the ventricular pacing lead often secured in the convenient right ventricular (RV) apical location. While RV pacing reduces symptoms and limitations associated with heart block, it may have detrimental effects on cardiac structure and function, leading to heart failure (HF) in some patients. RV pacing creates electrical dyssynchrony similar to a left-bundle branch block, with conduction occurring cell-by-cell rather than through the His-Purkinje network. Studies have shown that impairment of myocardial metabolism, structure, and function related to RV pacing occurs regionally (most prominently near the pacing site) and globally, within the left ventricle. Strategies being studied to prevent or treat pacing-induced intraventricular mechanical dyssynchrony and HF include: initial biventricular rather than RV pacing in selected patients, programming to avoid or minimize RV pacing, use of alternate (non-apical) RV pacing sites, echocardiographic screening for development of pacing-induced dyssynchrony and HF, and upgrade to biventricular pacing.
心脏起搏是治疗病态窦房结综合征或房室传导阻滞患者的常用方法，心室起搏导线通常固定在方便的右心室（RV）心尖位置。虽然 RV 起搏可减轻与心脏阻滞相关的症状和限制，但它可能对心脏结构和功能产生有害影响，导致一些患者出现心力衰竭（HF）。RV 起搏会产生类似于左束支传导阻滞的电不同步，电激动通过细胞逐个传导，而不是通过希氏-浦肯野系统。研究表明，与 RV 起搏相关的心肌代谢、结构和功能的损害在区域（最明显的是在起搏部位附近）和整体（在左心室）发生。目前正在研究预防或治疗起搏诱导的室内机械不同步和 HF 的策略包括：在选定的患者中初始行双心室起搏而不是 RV 起搏、编程以避免或最小化 RV 起搏、使用替代（非心尖）RV 起搏部位、超声心动图筛查起搏诱导的不同步和 HF 的发生、以及升级为双心室起搏。
