心脏起搏导线植入位点的优化更新  

Optimization and update of implantation sites for cardiac pacing leads

作　　者：景占斌(综述) 李万鹏[2] 黄晏(审校)[2] JING Zhanbin;LI Wanpeng;HUANG Yan(First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730030;Second Department of Cardiology,Gansu Provincial People’s Hospital,Lanzhou 730030,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730030 [2]甘肃省人民医院心内二科,兰州730030

出　　处：《临床与病理杂志》2023年第10期1865-1871,共7页Journal of Clinical and Pathological Research

摘　　要：心脏起搏是治疗有症状性心动过缓的有效方法。长期、高比例的右室心尖部起搏使患者发生心力衰竭、心房颤动的风险增加。传统双心室起搏通过右室心内膜和左室心外膜双心室同步起搏,并非是生理性的起搏,且无应答率较高。心脏传导系统起搏是一种利用心脏传导系统激动心室的生理性起搏,包括希氏束起搏和左束支区域起搏。与右心室起搏/双心室起搏相比,心脏传导系统起搏具有更好的心室电和机械同步性。同希氏束起搏相比,左束支区域起搏具有更佳的起搏参数(起搏阈值更低且平稳、较高的R波振幅)。通过阐述心脏起搏导线植入位点从右心室心尖部起搏到右心室间隔/流出道起搏,再到心脏传导系统起搏的优化更新,介绍各种起搏方式并比较不同起搏方式的优缺点,突显出生理性起搏的优势,并对生理性起搏的未来前景进行展望。Cardiac pacing is an effective method for treating symptomatic bradycardia.Prolonged and high-percentage right ventricular apical pacing increases the risk of heart failure and atrial fibrillation in patients.Traditional biventricular pacing,involving simultaneous pacing of the right ventricular endocardium and left ventricular epicardium,is not physiological and has a high non-response rate.His bundle pacing and left bundle branch area pacing are physiological pacing methods that utilize the cardiac conduction system to excite the ventricles.A large number of studies have shown that cardiac conduction system pacing has better ventricular electrical and mechanical synchronization compared to right ventricular pacing/biventricular pacing.Compared to His bundle pacing,left bundle branch area pacing,in particular,exhibits better pacing parameters(lower and smoother pacing threshold,higher R-wave amplitude).This article reviews the optimization and update of implantation sites for cardiac pacing leads,from right ventricular apical pacing to right ventricular septal/outflow tract septal pacing,and then to cardiac conduction system pacing,introduces various pacing methods,compares the advantages and disadvantages of different pacing methods,highlights the advantages of physiological pacing,and provides an outlook on the future prospects of physiological pacing.

关 键 词：心脏起搏 心脏传导系统 束支阻滞 希氏束起搏 左束支区域起搏 

分 类 号：R541.7[医药卫生—心血管疾病]