University of Chicago Medicine, Center for Arrhythmia Care | Heart and Vascular Center, Chicago, Illinois, USA.
Curr Opin Cardiol. 2020 May;35(3):295-307. doi: 10.1097/HCO.0000000000000735.
His bundle pacing (HBP) has emerged as a novel method to achieve electrical resynchronization in bundle branch block and as an alternative means to deliver cardiac resynchronization therapy (CRT). There are now data on HBP in CRT-eligible patients from cohort studies and a single pilot randomized controlled trial (RCT).
Early clinical data regarding HBP in heart failure have demonstrated echocardiographic and functional improvement similar to traditional biventricular pacing (BiV), mostly when utilized as a bailout to traditional BiV-CRT. A single pilot RCT, His-SYNC, showed a trend toward greater echocardiographic response in an on-treatment analysis, but was underpowered. No large RCTs have reported long-term clinical outcomes. In order to realize any benefit from HBP, output-dependent morphology changes must be demonstrated to ensure the conduction system capture is present. There may be a role for corrective HBP in patients with right bundle branch block and after atrioventricular node ablation, which is theoretically more desirable than traditional BiV. Importantly, however, HBP is likely not to benefit patients with nonspecific intraventricular conduction delay.
HBP is emerging as an alternative strategy for CRT and may have a role in patients in whom traditional BiV is not achievable or ineffective.
希氏束起搏（HBP）已成为一种实现束支传导阻滞患者电同步的新方法，也是提供心脏再同步治疗（CRT）的替代手段。目前，关于 CRT 适应证患者的 HBP 的数据来自队列研究和一项单中心随机对照试验（RCT）。
心力衰竭患者 HBP 的早期临床数据表明，超声心动图和功能改善与传统双心室起搏（BiV）相似，主要是当作为传统 BiV-CRT 的替代手段时。一项单中心 RCT（His-SYNC）研究显示，在治疗分析中，有更大的超声心动图反应趋势，但该研究的效力不足。没有大型 RCT 报道长期临床结局。为了从 HBP 中获得任何益处，必须证明输出依赖性形态改变，以确保存在传导系统捕获。在右束支传导阻滞和房室结消融后，HBP 可能对纠正有一定作用，从理论上讲，这比传统 BiV 更可取。然而，重要的是，HBP 可能不会使非特异性室内传导延迟的患者受益。
HBP 作为 CRT 的替代策略正在出现，对于传统 BiV 不可行或无效的患者可能具有一定作用。
