左束支区域起搏的现状和展望

Present and Future of Left Bundle Branch Area Pacing

希氏束和左束支区域的生理性起搏较右室心尖部起搏明显改善心脏的电机械同步性,改善心功能。希氏束起搏是最生理的起搏方式,而且可纠正大部分的完全性左束支传导阻滞,改善心脏再同步化,但也存在起搏阈值高、R波振幅低和潜在的希氏束远端病变风险。左束支呈扇形分布左室间隔内膜面下,起搏阈值和R波振幅同右室心尖部相似,而且左束支近端起搏可纠正病变于希氏束的左束支传导阻滞,可作为心脏再同步化治疗的备选方案。现就左束支的解剖、左束支区域起搏的电生理特点和左束支区域起搏的临床应用进行综述。

Compared with right ventricular apical pacing,the physiological pacing of His bundle pacing(HBP)and left bundle branch area pacing(LBBaP)significantly improved the electromechanical synchronization and cardiac function.HBP is the most physiological pacing,and can correct most of the complete left bundle branch block to improve cardiac resynchronization.Whereas,it has some shortages including high pacing threshold,low R-wave amplitude and potential risk of distal His bundle lesion.The pacing threshold and R wave amplitude of LBBaP are similar to that of the right ventricular apex pacing.Moreover,the LBBaP can correct the left bundle branch block,the lesion in His bundle,as an alternative to cardiac resynchronization.This article reviews the anatomy of the left bundle branch,the electrophysiological characteristics of LBBaP and the clinical application of LBBaP.