Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands.
Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes Barre, Pennsylvania, USA.
Heart. 2020 Dec;106(24):1883-1889. doi: 10.1136/heartjnl-2020-316849. Epub 2020 Oct 7.
The adverse effects of ventricular dyssynchrony induced by right ventricular (RV) pacing has led to alternative pacing strategies, such as biventricular, His bundle (HBP), LV septal (LVSP) and left bundle branch pacing (LBBP). Given the overlap, LVSP and LBBP are also collectively referred to as left bundle branch area pacing (LBBAP). Although among these alternative pacing sites HBP is theoretically the ideal strategy as it maintains a physiological ventricular activation, its application requires more skills and is associated with the most complications. LBBAP, where the ventricular pacing lead is advanced through the interventricular septum to its left side, creates ventricular activation that is only slightly more dyssynchronous. Preliminary studies have shown that LBBAP is feasible, safe and encounters less limitations than HBP. Further studies are needed to differentiate between LVSP and LBBP with regard to acute functional and long-term clinical outcome.
右心室（RV）起搏引起的心室不同步的不良反应促使人们采用了一些替代起搏策略，如双心室起搏、希氏束起搏（HBP）、左心室间隔部起搏（LVSP）和左束支区域起搏（LBBP）。由于 LVSP 和 LBBP 有一定程度的重叠，因此它们也被统称为左束支区域起搏（LBBAP）。尽管在这些替代起搏部位中，HBP 理论上是理想的策略，因为它维持了生理性心室激动，但它的应用需要更多的技术，并且与最多的并发症相关。LBBAP 是将心室起搏导线通过室间隔推进到其左侧，从而产生稍不协调的心室激动。初步研究表明，LBBAP 是可行、安全的，并且遇到的限制比 HBP 少。需要进一步的研究来区分 LVSP 和 LBBP 在急性功能和长期临床结果方面的差异。
