右心室心脏起搏升级双心室起搏的临床应用进展

Advances in Research of Upgrading from Right Ventricular Pacing to Biventricular Pacing in Pacemaker Patients with Chronic Heart Failure

心脏再同步化治疗是一项成熟应用于临床进展期心力衰竭合并左心收缩功能不全,心脏失同步患者治疗方法。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电机械失同步,心脏收缩功能下降最终发生心力衰竭。适时地将起搏患者右心室起搏系统升级为双心室起搏可以纠正右室起搏导致的心脏失同步,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,有效地避免了起搏对血流动力学和心功能的不良影响。近来短期研究发现这种起搏系统升级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。文章综述了右室心尖部起搏的病理生理及升级右室起搏到双室起搏治疗的相关临床试验、显效机制及存在的问题。

Cardiac resynchronization therapy {CRT） is now a recommended treatment in patients with advanced heart failure. Right ventricular apical （ RVA ） pacing alters normal activation, leads to remodeling of cardiac electrophysiology and myocardial tissue, and im- pairs heart function. Appropriate upgrading from right ventricular pacing to biventricular pacing in pacemaker patients with chronic heart fail- ure produces synchronous cardiac depolarization, prevents the deleterious effects on hemodynamies, and improves cardiac function relative to the sole use of RVA pacing. A series of short-term clinical trials have suggested that upgrading from right ventricular pacing to biventricular pacing in pacemaker patients with chronic heart failure pacing is an ideal cardiac pacing method relative to RVA pacing. This article reviews the pathophysiology of RVA pacing, the clinical trials , mechanisms, and unsolved issue of upgrading from right ventricular pacing to biven- tricular pacing.