Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Heart Rhythm. 2021 Jun;18(6):1024-1032. doi: 10.1016/j.hrthm.2021.02.011. Epub 2021 Feb 16.
Cardiac resynchronization therapy (CRT) greatly reduces morbidity and mortality in patients with dyssynchronous heart failure. However, despite tremendous efforts, response has been variable and can be further improved. Although optimizing left ventricular lead placement (LVLP) is arguably the cornerstone of CRT, the procedure of LVLP using the transvenous approach has remained largely unchanged for more than 2 decades. Improvements have been developed using scar location and electrical and/or mechanical mapping, and interest in conduction system pacing as an alternative to biventricular pacing has emerged recently. Conduction system pacing is promising but may not be suitable for all patients with dyssynchronous heart failure. This review underscores the importance of a patient-tailored approach and discusses the potential applications of both conduction system pacing and targeted biventricular CRT.
心脏再同步治疗（CRT）可显著降低心力衰竭患者的发病率和死亡率。然而，尽管付出了巨大的努力，反应仍然各不相同，可以进一步改善。虽然优化左心室导线放置（LVLP）可以说是 CRT 的基石，但 20 多年来，经静脉途径的 LVLP 程序基本上没有改变。已经开发了使用瘢痕位置和电和/或机械映射的改进，并且最近出现了对替代双心室起搏的传导系统起搏的兴趣。传导系统起搏很有前途，但可能并不适合所有心力衰竭患者。本综述强调了个体化治疗方法的重要性，并讨论了传导系统起搏和靶向双心室 CRT 的潜在应用。
