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首页> 外文期刊>Cardiovascular therapeutics >Advances in cardiac pacing: beyond the transvenous right ventricular apical lead.
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Advances in cardiac pacing: beyond the transvenous right ventricular apical lead.

机译：心脏起搏的进展：超出右室经静脉顶导。

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While for decades right ventricular (RV) apical pacing has been the standard of care for patients requiring pacemaker or defibrillator lead placement, investigators have sought alternatives to achieve more physiologic electrical activation of the heart and reduce long-term pathologic effects of nonphysiologic apical pacing. These investigations have included attempts at identifying superior pacing sites within the right atrium and RV and development of new leads to enhance specificity of sensing and capture. This review focuses on recent advances in alternative sites for pacing and developments in novel pacing technology ranging from intramyocardial electrodes to leadless pacemakers. First, there have been several studies demonstrating potential benefits of site-specific pacing, including His bundle pacing and RV outflow tract pacing in potentially attenuating electromechanical dyssynchrony and long-term functional decline seen with RV apical pacing. Available options for lead placement have been enhanced by development of intramyocardial electrodes that may significantly reduce far-field oversensing and nonchamber specific capture. With development of intramyocardial electrodes, the potential for atrioventricular septal pacing has recently been described, making synchronous activation of both ventricles with a one-lead system possible without crossing the tricuspid valve and offering an alternative to modern cardiac resynchronization therapy (CRT). Finally, recent advances in leadless pacemaker systems using ultrasound or magnetic fields are briefly discussed. The results of these studies suggest that there may be options to the RV apex, made possible by novel lead and pacemaker technology. These advances can potentially aid in reducing long-term negative effects of chronic pacemaker therapy.
机译：尽管几十年来，右心室（RV）根尖起搏一直是需要起搏器或除颤器导线放置的患者的治疗标准，但研究人员已寻求替代方法以实现更多的心脏生理电激活并减少非生理性根尖起搏的长期病理影响。这些研究包括尝试确定右心房和RV内的优越起搏部位，并开发新的导线以增强感知和捕获的特异性。这篇综述着重于起搏替代部位的最新进展以及新型起搏技术的发展，从心肌内电极到无铅起搏器。首先，已有几项研究证明了特定部位起搏的潜在益处，包括他的束起搏和RV流出道起搏可潜在地减轻机电不同步和RV顶端起搏所引起的长期功能下降。心肌内电极的开发增强了引线放置的可用选项，可显着减少远场过度感应和非腔室特异性捕获。随着心肌内电极的发展，最近已描述了房室间隔起搏的潜力，使得可以通过单导联系统同步激活两个心室而无需穿过三尖瓣，并为现代心脏再同步治疗（CRT）提供了替代方法。最后，简要讨论了使用超声波或磁场的无铅起搏器系统的最新进展。这些研究的结果表明，通过新的导联和起搏器技术可以使RV顶点具有多种选择。这些进展可能有助于减轻慢性起搏器治疗的长期负面影响。

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