Dilaveris Polychronis, Antoniou Christos Konstantinos, Manolakou Panagiota, Skiadas Ioannis, Konstantinou Konstantinos, Magkas Nikolaos, Xydis Panagiotis, Chrysohoou Christina, Gatzoulis Konstantinos, Tousoulis Dimitrios
First University Department of Cardiology, Hippokration Hospital; Athens-Greece.
Anatol J Cardiol. 2019 Sep;22(3):132-139. doi: 10.14744/AnatolJCardiol.2019.35006.
Cardiac resynchronization therapy constitutes a cornerstone in advanced heart failure treatment, when there is evidence of dyssynchrony, especially by electrocardiography. However, it is plagued both by persistently high (~30%) rates of nonresponse and by deterioration of right ventricular function, owing to iatrogenic dyssynchrony in the context of persistent apical pacing to ensure delivery of biventricular pacing. Left ventricular pacing has long been considered an alternative to standard biventricular pacing and can be achieved as easily as inserting a single pacing electrode in the coronary sinus. Although monoventricular left ventricular pacing has been proven to yield comparable results with the standard biventricular modality, it is the advent of preferential left ventricular pacing, combining both the powerful resynchronization potential of multipolar coronary sinus and right-sided electrodes acting in concert and the ability to preserve intrinsic, physiological right ventricular activation. In this review, we aim to present the underlying principles and modes for delivering left ventricular pacing, as well as to highlight advantages of preferential over monoventricular configuration. Finally, current clinical evidence, following implementation of automated algorithms, regarding performance of left ventricular as compared with biventricular pacing will be discussed. It is expected that the field of preferential left ventricular pacing will grow significantly over the following years, and its combination with other advanced pacing modalities may promote clinical status and prognosis of patients with advanced dyssynchronous heart failure.
心脏再同步治疗是晚期心力衰竭治疗的基石，尤其是在存在不同步证据时，通过心电图可明确显示。然而，该治疗方法存在两大问题：一是无反应率持续居高不下（约30%），二是右心室功能恶化，这是由于在持续心尖部起搏以确保双心室起搏的情况下，医源性不同步所致。长期以来，左心室起搏一直被视为标准双心室起搏的替代方法，且通过在冠状窦插入单个起搏电极就能轻松实现。尽管已证实单心室左心室起搏与标准双心室起搏方式的效果相当，但优先左心室起搏的出现，结合了多极冠状窦电极和右侧电极协同作用的强大再同步潜力以及保留固有生理性右心室激活的能力。在本综述中，我们旨在阐述左心室起搏的基本原理和方式，并强调优先左心室起搏相较于单心室起搏配置的优势。最后，将讨论在实施自动算法后，与双心室起搏相比，左心室起搏的当前临床证据。预计在未来几年，优先左心室起搏领域将显著发展，其与其他先进起搏方式的结合可能改善晚期不同步心力衰竭患者的临床状况和预后。
