Derndorfer Michael, Kollias Georgios, Martinek Martin, Pürerfellner Helmut
Ordensklinikum Linz Elisabethinen, Fadingerstraße 1, 4020 Linz, Austria.
J Clin Med. 2024 Jul 24;13(15):4320. doi: 10.3390/jcm13154320.
The current gold standard in device therapy for advanced heart failure (HF), which has been firmly established in HF management for more than 25 years, is classical biventricular pacing (BiV-CRT). In the last decade, a new pacing modality called conduction system pacing (CSP) has emerged as a variant for advanced cardiac device therapy. It provides pacing with preserved intrinsic cardiac activation by direct stimulation of the specific cardiac conduction system. The term CSP integrates the modalities of HIS bundle pacing (HBP) and left bundle branch area pacing (LBBAP), both of which have provided convincing data in smaller randomized and big non-randomized studies for the prevention of pacemaker-induced cardiomyopathy and for providing effective cardiac resynchronization therapy in patients with classical CRT-indication (primary approach or after failed CRT). Recent American guidelines proposed the term "cardiac physiological pacing" (CPP), which summarizes CSP including left ventricular septal pacing (LVSP), a technical variant of LBBAP together with classical BiV-CRT. The terms HOT-CRT (HIS-optimized CRT) and LOT-CRT (LBBP-optimized CRT) describe hybrid technologies that combine CSP with an additional coronary-sinus electrode, which is sometimes useful in patients with advanced HF and diffuse interventricular conduction delay. If CSP continues providing promising data that can be confirmed in big, randomized trials, it is likely to become the new gold standard for patients with an expected high percentage of pacing (>20%), possibly also for cardiac resynchronization therapy. CSP is a sophisticated new treatment option that has the potential to raise the term "cardiac resynchronization therapy" to a new level. The aim of this review is to provide basic technical, anatomical, and functional knowledge of these new pacemaker techniques in order to facilitate the understanding of the different modalities, as well as to provide an up-to-date overview of the existing randomized and non-randomized evidence, particularly in direct comparison to right ventricular and classical biventricular pacing.
在晚期心力衰竭（HF）的器械治疗中，经典双心室起搏（BiV-CRT）是目前的金标准，这一标准在HF管理领域已牢固确立超过25年。在过去十年中，一种名为传导系统起搏（CSP）的新起搏方式作为晚期心脏器械治疗的一种变体出现。它通过直接刺激特定的心脏传导系统，在保留心脏固有激活的情况下进行起搏。术语CSP整合了希氏束起搏（HBP）和左束支区域起搏（LBBAP）这两种方式，在较小规模的随机研究和大型非随机研究中，二者均为预防起搏器诱导的心肌病以及为具有经典CRT适应症的患者（主要方法或CRT失败后）提供有效的心脏再同步治疗提供了令人信服的数据。最近美国的指南提出了“心脏生理性起搏”（CPP）这一术语，它总结了CSP，包括左心室间隔起搏（LVSP），后者是LBBAP的一种技术变体，以及经典的BiV-CRT。术语HOT-CRT（希氏束优化CRT）和LOT-CRT（左束支起搏优化CRT）描述了将CSP与额外的冠状窦电极相结合的混合技术，这在晚期HF和弥漫性室内传导延迟的患者中有时很有用。如果CSP继续提供有前景的数据并能在大型随机试验中得到证实，它很可能成为起搏预期比例较高（>20%）患者的新金标准，可能也适用于心脏再同步治疗。CSP是一种复杂的新治疗选择，有可能将“心脏再同步治疗”提升到一个新水平。本综述的目的是提供这些新起搏器技术的基本技术、解剖和功能知识，以便于理解不同的方式，并提供现有随机和非随机证据的最新概述，特别是与右心室起搏和经典双心室起搏的直接比较。
