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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 is a well-established treatment for patients with clinically advanced heart failure with left ventricular systolic dysfunction and cardiac loss of synchrony. Right atrial apical pacing changes the normal cardiac contractile sequence of excitement, which leads to cardiac electrical mechanical synchronization, decreased cardiac contractility and eventually heart failure. Timely pacing in patients with right ventricular pacing system upgrade to biventricular pacing can correct right ventricular pacing caused by cardiac loss of synchronization to maximize the left and right biventricular normal electrical activation sequence and systolic synchronism effectively Avoid the adverse effects of pacing on hemodynamics and cardiac function. Recent short-term study found that this pacing system upgrade can significantly improve the synchronization of cardiac activity, thereby improving cardiac function and improve quality of life. This article reviews the pathophysiology of right ventricular apex pacing and the related clinical trials of upgrading right ventricular pacing to double ventricular pacing, the effective mechanism and existing problems.