Katta Maanya Rajasree, Abouzid Mohamed Riad Abdelgawad, Hameed Maha, Kaur Jasneet, Balasubramanian Suryakumar
From the University of La Verne, La Verne, CA.
Baptist Hospitals of Southeast Texas, TX.
Cardiol Rev. 2025;33(1):9-14. doi: 10.1097/CRD.0000000000000545. Epub 2023 Mar 13.
Cardiac pacing refers to the implantation tool serving as a treatment modality for various indications, the most common of which is symptomatic bradyarrhythmia. Left bundle branch pacing has been noted in the literature to be safer than biventricular pacing or His-bundle pacing in patients with left bundle branch block (LBBB) and heart failure, thereby becoming the focus of further research on cardiac pacing. A review of the literature was conducted using a combination of keywords, including "Left Bundle Branch Block," "Procedural techniques," "Left Bundle Capture," and "Complications." The following factors have been investigated as key criteria for direct capture: paced QRS morphology, peak left ventricular activation time, left bundle potential, nonselective and selective left bundle capture, and programmed deep septal stimulation protocol. In addition, complications of LBBP, inclusive of septal perforation, thromboembolism, right bundle branch injury, septal artery injury, lead dislodgement, lead fracture, and lead extraction, have also been elaborated on. Despite clinical implications based on clinical research comparing the use of LBBP with other forms such as right ventricular apex pacing, His-bundle pacing, biventricular pacing, and left ventricular septal pacing, a paucity in the literature on long-term effects and efficacy has been noted. LBBP can thus be considered to have a promising future in patients requiring cardiac pacing, assuming that additional research on clinical outcomes and the limitation of significant complications such as thromboembolism can be established.
心脏起搏是指作为各种适应症治疗方式的植入工具，其中最常见的是有症状的缓慢性心律失常。文献表明，对于左束支传导阻滞（LBBB）和心力衰竭患者，左束支起搏比双心室起搏或希氏束起搏更安全，因此成为心脏起搏进一步研究的重点。使用包括“左束支传导阻滞”“手术技术”“左束支捕获”和“并发症”等关键词组合对文献进行了综述。以下因素已被作为直接捕获的关键标准进行研究：起搏QRS形态、左心室激活峰值时间、左束支电位、非选择性和选择性左束支捕获以及程控深间隔刺激方案。此外，还阐述了左束支起搏的并发症，包括间隔穿孔、血栓栓塞、右束支损伤、间隔动脉损伤、导线脱位、导线断裂和导线拔除。尽管基于临床研究对左束支起搏与右心室心尖起搏、希氏束起搏、双心室起搏和左心室间隔起搏等其他形式的使用进行了临床意义比较，但文献中关于长期影响和疗效的内容较少。因此，如果能够对临床结果以及血栓栓塞等重大并发症的局限性进行更多研究，那么对于需要心脏起搏的患者而言，左束支起搏有望拥有广阔的前景。
