右心室间隔部心脏起搏研究进展

Advances in Research into Right Ventricular Septum Cardiac Pacing

右心室心尖部起搏改变了正常心脏的激动收缩顺序从而导致心脏组织及电学重塑、心脏收缩功能下降最终发生心力衰竭。右心室间隔部起搏可以获得接近正常生理的心室激动顺序,最大限度保持左、右双心室间正常的电激动顺序和收缩同步性;同时改善左房、左室的收缩同步性,增加左心室的舒张充盈时间,减少二尖瓣反流,有效地避免了起搏对血流动力学和心功能的不良影响。近来短期和长期研究发现右室间隔部心脏起搏可明显改善心脏活动的同步性,从而改善心功能、提高生活质量,认为右室间隔部心脏起搏治疗是对生理性心脏起搏的再认识。文章综述了右室心尖部起搏的病理生理及右室间隔部起搏治疗相关临床试验、显效机制、技术关键及存在的问题。

Right ventricular apical （ RVA） pacing alters normal activation, and leads to remodelling of cardiac electrophysiology and myocardial tissue, and impairs heart function. Right ventricular septum （ RVS ） cardiac pacing produces synchronous cardiac depolarization （ atrioventricular, intra-ventricular, inter-ventricular ） , prevents deleterious effects on hemodynamics and heart function, and improves cardiac function relative to RVA pacing. A series of short- and long-term clinical trials has suggested that RVS pacing is an ideal physiology cardiac pacing, compared to RVA pacing. This article reviews the pathophysiology of RVA pacing and clinical trials, mechanisms, technique, and unsolved issues of RVS pacing.