Muthumala Amal, Vijayaraman Pugazhendhi
North Middlesex University Hospital and St Bartholomew's Hospital, London, UK.
Geisinger Commonwealth School of Medicine, Director, Cardiac Electrophysiology, Geisinger Heart Institute, MC 36-10, Mountain Blvd, 1000, Wilkes-Barre, PA, USA.
Herzschrittmacherther Elektrophysiol. 2020 Jun;31(2):117-123. doi: 10.1007/s00399-020-00679-7. Epub 2020 May 6.
His-Purkinje conduction system pacing (HPCSP) in the form of His bundle pacing and left bundle branch pacing allows normal ventricular activation, thereby preventing the adverse consequences of right ventricular pacing. One potential area where HPCSP could be used is in the field of atrioventricular (AV) node ablation in patients with atrial fibrillation refractory to medical therapy and/or catheter ablation. His bundle pacing has been established for several years, with centres from North America, Europe and China publishing their experience. The differing patterns of His bundle capture are clearly described with established guidance as to how to implant such systems. Left bundle branch pacing has only recently been reported, but there are several advantages with better pacing parameters and lower risk of threshold change after AV node ablation. Six studies have been identified in the literature which describe the experience of His bundle pacing in patients requiring AV node ablation. Overall the results are positive and favour this new technique; however, they are limited by low numbers of patients and non-randomised study design. An observational study was recently published demonstrating better outcomes with left bundle branch pacing in a small number of patients with left ventricular dysfunction and atrial fibrillation that underwent AV node ablation. HPCSP has the potential to be the primary pacing modality in patients with atrial fibrillation requiring AV node ablation. However, it is essential that this is confirmed in large randomised clinical trials.
希氏束起搏和左束支起搏形式的希氏-浦肯野传导系统起搏可实现正常的心室激动，从而避免右心室起搏的不良后果。希氏-浦肯野传导系统起搏的一个潜在应用领域是在药物治疗和/或导管消融难治性心房颤动患者的房室结消融方面。希氏束起搏已经开展多年，北美、欧洲和中国的一些中心都发表了相关经验。希氏束夺获的不同模式已有清晰描述，并且有关于如何植入此类系统的既定指导。左束支起搏直到最近才被报道，但它具有一些优势，如起搏参数更好，且在房室结消融后阈值变化风险较低。在文献中已确定有六项研究描述了希氏束起搏在需要进行房室结消融患者中的应用经验。总体而言，结果是积极的，支持这项新技术；然而，这些研究受限于患者数量少和非随机研究设计。最近发表的一项观察性研究表明，在少数接受房室结消融的左心室功能不全和心房颤动患者中，左束支起搏的效果更好。希氏-浦肯野传导系统起搏有可能成为需要进行房室结消融的心房颤动患者的主要起搏方式。然而，这一点必须在大型随机临床试验中得到证实。
