Jeanrenaud X
Département de Médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse.
Ann Cardiol Angeiol (Paris). 1997 Oct;46(8):499-505.
Cardiac pacing using the apex of the right ventricle as site of excitation induces asynchronous contraction between the right ventricle and the left ventricle as well as inversion of the normal left ventricular activation sequence. These two phenomena are responsible for alteration of septal kinetics and overall contractility. It has recently been demonstrated that these alterations can be used to advantage to reduce the degree of subaortic obstruction of patients suffering from hypertrophic and obstructive cardiomyopathy, and to improve their exercise tolerance. Using an opposite approach, consisting of reducing the degree of asynchronous contraction related to the presence of intraventricular conduction disorders, while optimizing atrioventricular synchronism, new pacing methods have recently been able to improve cardiac output and functional tolerance of some patients suffering from dilated cardiomyopathy. Although cardiac pacing can now be considered to be an alternative a surgery for the treatment of refractory forms of hypertrophic and obstructive cardiomyopathy, it still constitutes a research technique in the field of dilated cardiomyopathy.
以右心室心尖作为兴奋部位进行心脏起搏会诱发右心室和左心室之间的异步收缩，以及正常左心室激活顺序的倒置。这两种现象会导致室间隔动力学和整体收缩力的改变。最近已证明，这些改变可被用于降低肥厚性梗阻性心肌病患者的主动脉瓣下梗阻程度，并提高其运动耐量。采用相反的方法，即减少与室内传导障碍相关的异步收缩程度，同时优化房室同步性，新的起搏方法最近已能够提高一些扩张型心肌病患者的心输出量和功能耐量。尽管现在心脏起搏可被视为治疗难治性肥厚性梗阻性心肌病的一种替代手术，但在扩张型心肌病领域它仍然是一种研究技术。
