无导线左心室心内膜起搏和左束支区域起搏用于心脏再同步治疗

Sidhu Baldeep S, Gould Justin, Elliott Mark K, Mehta Vishal, Niederer Steven, Rinaldi Christopher A

School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.

Guy's and St Thomas' Hospital, London, UK.

Arrhythm Electrophysiol Rev. 2021 Apr;10(1):45-50. doi: 10.15420/aer.2020.46.

Cardiac resynchronisation therapy is an important intervention to reduce mortality and morbidity, but even in carefully selected patients approximately 30% fail to improve. This has led to alternative pacing approaches to improve patient outcomes. Left ventricular (LV) endocardial pacing allows pacing at site-specific locations that enable the operator to avoid myocardial scar and target areas of latest activation. Left bundle branch area pacing (LBBAP) provides a more physiological activation pattern and may allow effective cardiac resynchronisation. This article discusses LV endocardial pacing in detail, including the indications, techniques and outcomes. It discusses LBBAP, its potential benefits over His bundle pacing and procedural outcomes. Finally, it concludes with the future role of endocardial pacing and LBBAP in heart failure patients.

心脏再同步治疗是降低死亡率和发病率的重要干预措施，但即使在精心挑选的患者中，仍有约30%的患者未能改善。这促使人们采用替代起搏方法来改善患者预后。左心室心内膜起搏允许在特定部位起搏，使操作者能够避开心肌瘢痕并针对最晚激动区域。左束支区域起搏（LBBAP）提供了更符合生理的激动模式，可能实现有效的心脏再同步。本文详细讨论了左心室心内膜起搏，包括适应证、技术和结果。还讨论了LBBAP、其相对于希氏束起搏的潜在优势以及手术结果。最后，总结了心内膜起搏和LBBAP在心力衰竭患者中的未来作用。