希浦氏系统起搏对右心功能影响的研究现状

R54Research status of the impact of His-Purkinje bundle pacing on right heart function

传统右心室起搏(RVP)技术可引起三尖瓣反流、起搏器综合征等问题,理论上同步化更优的希浦氏系统起搏(HPBP)包括希氏束起搏(HBP)及左束支起搏(LBBP)可克服上述不足。HBP作为生理性起搏的代表,对左心功能及预后的良性作用已得到公认。少许研究显示HBP对右心功能有改善作用,但存在植入困难、远期阈值高等问题。LBBP作为HBP简易实用的替代技术,理论上的电-机械不同步会导致右心室功能受损,另外,LBBP电极跨越三尖瓣所致的机械性障碍也可能是导致右心室功能不良的因素。目前初步证据显示,HPBP中电-机械同步因素在右心功能中扮演更关键的角色,但对于LBBP而言缺乏足够的证据支持且机制不明。总之,目前HPBP对右心功能的影响研究不足,右心功能的无创评价指标也缺乏简易通用的单一金标准。新兴的双束支起搏(BBBP)技术可能同时避免HBP技术难度和LBBP不同步的缺点,但对右心功能的影响也需要进一步评价。

Traditional right ventricular pacing technology can cause problems such as tricuspid regurgitation and pacemaker syndrome.Theoretically,physiological pacing of conduction system with better synchronization[His-Purkinje system pacing(HPBP)includes His bundle pacing(HBP)and left bundle branch pacing(LBBP)]can overcome the above shortcomings.As a representative of physiological pacing,HBP has been recognized for its benign eff ect on left ventricular function and prognosis.A few studies have also shown that HBP can improve right ventricular function,but the problems of high implantation difficulty and high long-term threshold cannot be ignored.LBBP,as a simple and practical alternative technology of HBP,will theoretically lead to impaired right ventricular function due to its electrical mechanical asynchrony.In addition,LBBP electrode crosses tricuspid valve,just like the traditional right ventricular pacing electrode cause the mechanical barrier and aff ects tricuspid valve closure,which may also be an adverse factor leading to right ventricular dysfunction.At present,the preliminary evidence shows that the electro-mechanical synchronization factor seems to play a more critical role in the right ventricular function in HPBP,but it lacks sufficient evidence-based support and the mechanism is unclear,especially for LBBP.In short,the current research on the impact of HPBP on right heart function is insufficient.There is a lack of simple and universal single gold standard for non-invasive evaluation of right heart function,which needs to combine different indicators for comprehensive evaluation.The novel bilateral bundle branch pacing(BBBP)technology may be a reasonable scheme to avoid the technical barrier of HBP and the asynchrony from LBBP at the same time,and its impact on right ventricular function also needs further evaluation.