Department of Internal Medicine, University of Chicago Medicine, Chicago, USA.
Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, USA.
Curr Cardiol Rep. 2022 Aug;24(8):959-978. doi: 10.1007/s11886-022-01723-3. Epub 2022 Jun 9.
Conduction system pacing (CSP) has emerged as a means to preserve or restore physiological ventricular activation via pacing at the His bundle or at more distal targets in the conduction system, including the left bundle branch area. This review examines strengths, weaknesses, and clinical applications of CSP performed via these approaches.
His bundle pacing (HBP) has been successfully utilized for standard bradyarrhythmia indications and for QRS correction among patients receiving devices for cardiac resynchronization therapy (CRT). Limitations of HBP pacing have included implant complexity and rising pacing thresholds over time. Left bundle branch area pacing (LBBAP) appears to deliver similar physiological benefits with shorter implant times and more stable thresholds. More recently, hybrid systems utilizing HBP or LBBAP in combination with left ventricular leads have been used to treat heart failure (HF) patients, and may be useful in multilevel or mixed conduction blocks. There is growing interest in CSP for bradycardia and HF indications, although high quality data with randomized controlled trials are needed to help guide future treatment paradigms.
通过希氏束或传导系统中更远端的靶点（包括左束支区域）起搏，以保存或恢复生理性心室激动，传导系统起搏（CSP）已经成为一种手段。本文回顾了通过这些方法进行 CSP 的优缺点及临床应用。
希氏束起搏（HBP）已成功用于标准缓慢性心律失常适应证，以及接受心脏再同步治疗（CRT）装置的患者的 QRS 校正。HBP 起搏的局限性包括植入的复杂性和起搏阈值随时间的升高。左束支区域起搏（LBBAP）似乎具有相似的生理性益处，植入时间更短，阈值更稳定。最近，利用 HBP 或 LBBAP 与左心室导联相结合的混合系统已被用于治疗心力衰竭（HF）患者，并且在多水平或混合传导阻滞中可能有用。对于心动过缓和 HF 适应证的 CSP 越来越感兴趣，但需要具有随机对照试验的高质量数据来帮助指导未来的治疗模式。
