Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.
Department of Electrophysiology, Republican Specialized Scientific Practical Medical Center of Cardiology, Osiyo St. 4, 100052 Tashkent, Uzbekistan.
Eur Heart J Cardiovasc Imaging. 2024 Jun 28;25(7):879-887. doi: 10.1093/ehjci/jeae090.
Traditional right ventricular pacing (RVP) has been linked to the deterioration of both left ventricular diastolic and systolic function. This worsening often culminates in elevated rates of hospitalization due to heart failure, an increased risk of atrial fibrillation, and increased morbidity. While biventricular pacing (BVP) has demonstrated clinical and echocardiographic improvements in patients afflicted with heart failure and left bundle branch block, it has also encountered significant challenges such as a notable portion of non-responders and procedural failures attributed to anatomical complexities. In recent times, the interest has shifted towards conduction system pacing, initially, His bundle pacing, and more recently, left bundle branch area pacing, which are seen as promising alternatives to established methods. In contrast to other approaches, conduction system pacing offers the advantage of fostering more physiological and harmonized ventricular activation by directly stimulating the His-Purkinje network. This direct pacing results in a more synchronized systolic and diastolic function of the left ventricle compared with RVP and BVP. Of particular note is the capacity of conduction system pacing to yield a shorter QRS, conserve left ventricular ejection fraction, and reduce rates of mitral and tricuspid regurgitation when compared with RVP. The efficacy of conduction system pacing has also been found to have better clinical and echocardiographic improvement than BVP in patients requiring cardiac resynchronization. This review will delve into myocardial function in conduction system pacing compared with that in RVP and BVP.
传统的右心室起搏（RVP）与左心室舒张和收缩功能的恶化有关。这种恶化常常导致心力衰竭住院率升高、心房颤动风险增加和发病率增加。虽然双心室起搏（BVP）已在心力衰竭和左束支传导阻滞患者中显示出临床和超声心动图的改善，但它也遇到了一些重大挑战，例如相当一部分无反应者和由于解剖结构复杂导致的程序失败。最近，人们对心脏传导系统起搏的兴趣发生了转变，最初是希氏束起搏，最近是左束支区域起搏，它们被视为替代传统方法的有前途的选择。与其他方法相比，心脏传导系统起搏通过直接刺激希氏-浦肯野纤维网络提供了促进更生理和协调的心室激活的优势。与 RVP 和 BVP 相比，这种直接起搏导致左心室收缩和舒张功能更加同步。值得注意的是，与 RVP 相比，心脏传导系统起搏具有产生更短 QRS 波、保持左心室射血分数和降低二尖瓣和三尖瓣反流率的能力。在需要心脏再同步的患者中，心脏传导系统起搏的疗效也被发现比 BVP 具有更好的临床和超声心动图改善。本综述将深入探讨心脏传导系统起搏与 RVP 和 BVP 相比的心肌功能。
