Israel Carsten W, Tribunyan Sona, Richter Sergio
Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
Abteilung für Elektrophysiologie, Herzzentrum Leipzig und Universität Leipzig, Leipzig, Deutschland.
Herzschrittmacherther Elektrophysiol. 2020 Jun;31(2):135-143. doi: 10.1007/s00399-020-00689-5.
His bundle pacing (HBP) allows ventricular excitation through the entire cardiac conduction system, resulting in a better synchronicity and efficacy of contraction compared to myocardial pacing. Due to better, dedicated implantation tools and exact practical implantation recommendations, HBP has developed into a form of stimulation that can be successfully applied with reasonable time and effort in >90% of patients. The rate of lead dislodgement and threshold increase is similar to conventional pacemaker systems. Despite a rather weak data base and a paucity of randomized trials, HBS represents an alternative to conventional right or biventricular pacing in the following conditions: (1) high-degree atrioventricular (AV) block with expected ventricular pacing >20% of the time, (2) AV block 1st degree with long PQ (alone or in combination with intermittent 2nd to 3rd degree AV block or sick sinus syndrome), (3) AV node ablation due to refractory atrial fibrillation, and (4) upgrade in pacing-induced cardiomyopathy. Moreover, HBP may be useful in context with cardiac resynchronization therapy (CRT). Left bundle branch block below the level of His represents a limitation of HBP. Therefore, more recently left bundle branch pacing (LBBP) has been introduced to correct left bundle branch block. LBBP seems to be possible in a wider anatomic area and may be easier to implant. However, LBBP requires active screw-in of the lead deep into the ventricular septum. Experience with this new technique is limited, particularly regarding long-term performance.
希氏束起搏（HBP）可使心室通过整个心脏传导系统兴奋，与心肌起搏相比，收缩的同步性和有效性更好。由于有更好的专用植入工具和确切的实际植入建议，HBP已发展成为一种刺激方式，在90%以上的患者中能以合理的时间和精力成功应用。导线脱位率和阈值升高率与传统起搏器系统相似。尽管数据库相当薄弱且缺乏随机试验，但在以下情况下，希氏束起搏是传统右心室或双心室起搏的一种替代方法：（1）高度房室传导阻滞，预计心室起搏时间>20%；（2）一度房室传导阻滞伴长PQ间期（单独或合并间歇性二度至三度房室传导阻滞或病态窦房结综合征）；（3）因难治性心房颤动而行房室结消融术；（4）起搏诱导性心肌病的升级。此外，HBP在心脏再同步治疗（CRT）中可能有用。希氏束水平以下的左束支传导阻滞是HBP的一个限制。因此，最近引入了左束支起搏（LBBP）来纠正左束支传导阻滞。LBBP似乎在更广泛的解剖区域可行，且可能更容易植入。然而，LBBP需要将导线主动旋入心室间隔深处。这项新技术的经验有限，尤其是在长期性能方面。
