Wijesuriya Nadeev, Elliott Mark K, Mehta Vishal, De Vere Felicity, Strocchi Marina, Behar Jonathan M, Niederer Steven A, Rinaldi Christopher A
School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Front Physiol. 2023 Jan 26;14:1054095. doi: 10.3389/fphys.2023.1054095. eCollection 2023.
Non-responders to Cardiac Resynchronization Therapy (CRT) represent a high-risk, and difficult to treat population of heart failure patients. Studies have shown that these patients have a lower quality of life and reduced life expectancy compared to those who respond to CRT. Whilst the first-line treatment for dyssynchronous heart failure is "conventional" biventricular epicardial CRT, a range of novel pacing interventions have emerged as potential alternatives. This has raised the question whether these new treatments may be useful as a second-line pacing intervention for treating non-responders, or indeed, whether some patients may benefit from these as a first-line option. In this review, we will examine the current evidence for four pacing interventions in the context of treatment of conventional CRT non-responders: CRT optimization; multisite left ventricular pacing; left ventricular endocardial pacing and conduction system pacing.
心脏再同步治疗（CRT）无反应者是心力衰竭患者中高危且难以治疗的群体。研究表明，与CRT有反应者相比，这些患者的生活质量较低，预期寿命缩短。虽然不同步心力衰竭的一线治疗是“传统的”双心室心外膜CRT，但一系列新型起搏干预措施已成为潜在的替代方案。这就提出了一个问题，即这些新治疗方法作为治疗无反应者的二线起搏干预措施是否有用，或者实际上，一些患者作为一线选择是否可能从这些治疗方法中获益。在本综述中，我们将在治疗传统CRT无反应者的背景下，研究四种起搏干预措施的现有证据：CRT优化；多部位左心室起搏；左心室内膜起搏和传导系统起搏。
