Zhang Shigeng, Shan Qijun
The First Clinical Medical School, Nanjing Medical University, Gulou District, No.140 Hanzhong Road, Nanjing, Jiangsu, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University (People's Hospital of Jiangsu Province), Nanjing, 210029, Jiangsu, China.
Heart Fail Rev. 2022 Nov;27(6):2181-2186. doi: 10.1007/s10741-021-10213-7. Epub 2022 Mar 14.
Left bundle branch block (LBBB) is common in heart failure patients, and could induce dyssynchrony of ventricular contraction, deterioration of cardiac function, and increased mortality. Cardiac resynchronization therapy (CRT) with biventricular pacing reduces ventricular dyssynchrony, heart failure hospitalization, and all-cause mortality in heart failure patients with LBBB. However, there are approximately 30% nonresponders and 10% of patients remain untreated owing to an unsuitable coronary sinus vein. His bundle pacing (HBP) is a more physiological pacing modality which has showed inspiring outcomes in heart failure patients with LBBB, but is limited by implantation challenges, lower success rates, and high pacing capture threshold. Recently, left bundle branch pacing (LBBP), defined as the capture of left bundle branch via transventricular septal approach, has emerged as a newly physiological pacing modality, which is implanted slightly distal to the His bundle. Early clinical studies have demonstrated the procedural feasibility of LBBP with rare complications and high success rate. Recent studies have indicated its potential to be an alternative for CRT. Synchronization effect and the current status of LBBP in the field of CRT are summarized in this paper.
左束支传导阻滞（LBBB）在心力衰竭患者中很常见，可导致心室收缩不同步、心功能恶化及死亡率增加。双心室起搏的心脏再同步治疗（CRT）可减少LBBB心力衰竭患者的心室不同步、心力衰竭住院率及全因死亡率。然而，约有30%的患者无反应，且由于冠状静脉窦不合适，有10%的患者仍未接受治疗。希氏束起搏（HBP）是一种更符合生理的起搏方式，在LBBB心力衰竭患者中已显示出令人鼓舞的结果，但受植入挑战、较低成功率及高起搏夺获阈值的限制。最近，经室间隔途径起搏左束支的左束支起搏（LBBP）已成为一种新的符合生理的起搏方式，其植入位置略低于希氏束。早期临床研究已证明LBBP的手术可行性，并发症罕见且成功率高。近期研究表明其有可能成为CRT的替代方法。本文总结了LBBP在CRT领域的同步化效果及现状。
