Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Cardiovasc Drugs Ther. 2022 Aug;36(4):763-775. doi: 10.1007/s10557-021-07163-5. Epub 2021 Mar 2.
Cardiac implantable electronic devices (CIEDs) are essential for the management of a variety of cardiac conditions, including tachyarrhythmias, bradyarrhythmias, and medically refractory heart failure (HF). Recent advancements in CIED technology have led to innovative solutions that overcome shortcomings associated with traditional devices or address unmet needs. Leadless pacemakers, subcutaneous implantable cardioverter defibrillators (ICDs), and extravascular ICDs eliminate lead-related complications common with conventional pacemakers or ICDs. Conduction system pacing (His bundle pacing and left bundle branch pacing) is a more physiologic method of pacing and avoids the deleterious consequences associated with long-term right ventricular pacing. For HF-related devices, cardiac contractility modulation is an emerging therapy that bridges a gap for many patients ineligible for cardiac resynchronization therapy and has been shown to improve HF symptoms and decrease hospitalizations and mortality in select patients. Implantable pulmonary artery pressure monitors help guide HF management and reduce hospitalizations. Lastly, new phrenic nerve stimulating devices are being utilized to treat central sleep apnea, a common comorbidity associated with HF. While further long-term studies are still underway for many of these new technologies, it is anticipated that these devices will become indispensable therapeutics in the expanding cardiovascular armamentarium.
心脏植入式电子设备（CIEDs）对于管理各种心脏疾病至关重要，包括心动过速、心动过缓和药物难治性心力衰竭（HF）。CIED 技术的最新进展带来了创新的解决方案，克服了传统设备的缺点或满足了未满足的需求。无导线起搏器、皮下植入式心律转复除颤器（ICD）和血管外 ICD 消除了与传统起搏器或 ICD 相关的导线相关并发症。传导系统起搏（希氏束起搏和左束支起搏）是一种更生理性的起搏方法，可以避免长期右心室起搏相关的有害后果。对于 HF 相关设备，心脏收缩力调节是一种新兴的治疗方法，为许多不符合心脏再同步治疗标准的患者提供了治疗途径，并已证明可改善 HF 症状，减少住院次数和死亡率。植入式肺动脉压监测器有助于指导 HF 管理并减少住院次数。最后，新型膈神经刺激装置正被用于治疗与 HF 相关的中枢性睡眠呼吸暂停，这是一种常见的合并症。虽然这些新技术中的许多仍在进行长期研究，但预计这些设备将成为心血管领域不断扩展的治疗武器中不可或缺的治疗方法。
