Liu Peng, Wang Qiaozhu, Sun Hongke, Qin Xinghua, Zheng Qiangsun
Department of Cardiology, The Second Affiliate Hospital of Xi'an Jiaotong University, Xi'an, China.
School of Life Sciences, Northwestern Polytechnical University, Xi'an, China.
Front Cardiovasc Med. 2021 Mar 23;8:630399. doi: 10.3389/fcvm.2021.630399. eCollection 2021.
Cardiac pacing is an effective therapy for treating patients with bradycardia due to sinus node dysfunction or atrioventricular block. However, traditional right ventricular apical pacing (RVAP) causes electric and mechanical dyssynchrony, which is associated with increased risk for atrial arrhythmias and heart failure. Therefore, there is a need to develop a physiological pacing approach that activates the normal cardiac conduction and provides synchronized contraction of ventricles. Although His bundle pacing (HBP) has been widely used as a physiological pacing modality, it is limited by challenging implantation technique, unsatisfactory success rate in patients with wide QRS wave, high pacing capture threshold, and early battery depletion. Recently, the left bundle branch pacing (LBBP), defined as the capture of left bundle branch (LBB) via transventricular septal approach, has emerged as a newly physiological pacing modality. Results from early clinical studies have demonstrated LBBP's feasibility and safety, with rare complications and high success rate. Overall, this approach has been found to provide physiological pacing that guarantees electrical synchrony of the left ventricle with low pacing threshold. This was previously specifically characterized by narrow paced QRS duration, large R waves, fast synchronized left ventricular activation, and correction of left bundle branch block. Therefore, LBBP may be a potential alternative pacing modality for both RVAP and cardiac resynchronization therapy with HBP or biventricular pacing (BVP). However, the technique's widespread adaptation needs further validation to ascertain its safety and efficacy in randomized clinical trials. In this review, we discuss the current knowledge of LBBP.
心脏起搏是治疗因窦房结功能障碍或房室传导阻滞导致心动过缓患者的有效疗法。然而，传统的右心室心尖部起搏（RVAP）会引起电和机械不同步，这与房性心律失常和心力衰竭风险增加相关。因此，需要开发一种生理性起搏方法，以激活正常的心脏传导并使心室同步收缩。尽管希氏束起搏（HBP）已被广泛用作一种生理性起搏方式，但其受到植入技术具有挑战性、QRS波增宽患者成功率不理想、起搏夺获阈值高以及电池早期耗尽等限制。最近，经室间隔途径夺获左束支（LBB）的左束支起搏（LBBP）已成为一种新的生理性起搏方式。早期临床研究结果已证明LBBP的可行性和安全性，并发症罕见且成功率高。总体而言，已发现这种方法可提供生理性起搏，保证左心室电同步且起搏阈值低。这以前具体表现为起搏QRS波时限窄、R波高大、左心室快速同步激活以及左束支传导阻滞得到纠正。因此，LBBP可能是RVAP以及HBP或双心室起搏（BVP）心脏再同步治疗的一种潜在替代起搏方式。然而，该技术的广泛应用需要进一步验证其在随机临床试验中的安全性和有效性。在本综述中，我们讨论了关于LBBP的当前知识。
