Roberts Paul Richard, Iacopino Saverio
Faculty of Medicine, University of Southampton, University Road, Southampton SO17 1BJ, UK.
GVM Care & Research, Maria Cecilia Hospital, Cotignola, RA, Italy.
Eur Heart J Suppl. 2025 Mar 24;27(Suppl 2):ii14-ii20. doi: 10.1093/eurheartjsupp/suae090. eCollection 2025 Mar.
Leadless pacing has been established as an effective and safe therapy. The majority of published data relates to an older population. However, this therapy may be particularly attractive for a younger (<40 years) population where the complications of transvenous devices can be enhanced. These include having leads in the vasculature for a longer period of time and the need for more generator changes over a longer time frame that may increase the rate of complications, e.g. infection. There is increasing evidence that leadless pacing is safe and effective in a younger population that may include specific patient groups such as those that require infrequent pacing, e.g. cardioinhibitory vasovagal syncope. Additionally, leadless pacing may be particularly suited to patients with adult congenital heart disease where conventional access with transvenous devices may be challenging. There are also some other groups such as neuromuscular disorders associated with conduction system disease that may benefit. The paediatric population is a further group that offers many challenges for pacing and so may be considered for leadless pacing. There is an increasing evidence base for the use of a superior jugular approach in this population rather than the conventional femoral approach. Further evidence to support leadless pacing would be enhanced with prospective randomized controlled studies in the population under the age of 40 years.
无导线起搏已被确立为一种有效且安全的治疗方法。大多数已发表的数据涉及老年人群。然而，这种治疗方法对于年轻（<40岁）人群可能特别有吸引力，因为经静脉装置的并发症在这类人群中可能会增加。这些并发症包括血管系统中导线留置时间更长，以及在更长时间内需要更换更多的发生器，这可能会增加并发症的发生率，例如感染。越来越多的证据表明，无导线起搏在年轻人群中是安全有效的，这可能包括特定的患者群体，如那些需要不频繁起搏的患者，例如心脏抑制型血管迷走性晕厥患者。此外，无导线起搏可能特别适合患有成人先天性心脏病的患者，因为经静脉装置的传统入路可能具有挑战性。还有其他一些群体，如与传导系统疾病相关的神经肌肉疾病患者，可能会从中受益。儿科人群是另一个在起搏方面面临诸多挑战的群体，因此可能会考虑采用无导线起搏。越来越多的证据支持在该人群中采用颈静脉上入路而非传统的股静脉入路。在40岁以下人群中进行前瞻性随机对照研究，将进一步增强支持无导线起搏的证据。
