Sharma Parikshit S, Ellenbogen Kenneth A, Trohman Richard G
Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
Virginia Commonwealth University, Richmond, VA, USA.
J Cardiovasc Electrophysiol. 2017 Apr;28(4):458-465. doi: 10.1111/jce.13154. Epub 2017 Jan 25.
Long-term right ventricular (RV) apical pacing has been associated with an increased risk of death, heart failure, and atrial fibrillation (AF). Alternative sites for RV pacing have not proven to be superior to RV apical pacing. Cardiac resynchronization therapy (CRT) using a biventricular (BiV) lead system is indicated for patients with a low left ventricular ejection fraction and QRS prolongation, but there remains about a 25-30% nonresponse rate. CRT has been less effective for nonleft bundle branch block conduction delay and with normal/low normal left ventricular function. Over the past decade, there have been more data on the feasibility and advantages of pacing at the His Bundle (HB) region. We review the anatomy and physiology of the HB, the available data on permanent HB pacing, its current and potential future applications.
长期右心室心尖部起搏与死亡、心力衰竭及心房颤动（AF）风险增加相关。右心室起搏的其他部位尚未被证明优于右心室心尖部起搏。使用双心室（BiV）导联系统的心脏再同步治疗（CRT）适用于左心室射血分数低且QRS波增宽的患者，但仍有大约25%-30%的无反应率。对于非左束支传导阻滞性传导延迟及左心室功能正常/轻度降低的患者，CRT效果较差。在过去十年中，关于希氏束（HB）区域起搏的可行性和优势有了更多数据。我们综述了HB的解剖学和生理学、永久性HB起搏的现有数据、其当前及潜在的未来应用。
