樊晓寒,朱浩杰

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院心律失常中心

摘要(Abstract)：

临床实践中，对于宽QRS波、双心室电机械收缩不同步的心力衰竭患者，通过双心室起搏（BiVP）实现双心室电机械同步化的心脏再同步化治疗（CRT）目前已被多个国际心力衰竭和起搏指南推荐。BiVP-CRT经多项临床研究证实可有效改善心力衰竭患者心功能、减少心力衰竭再入院、逆转左心室重构、降低死亡风险。然而，BiVP-CRT手术仍面临着冠状窦插管失败、无理想靶静脉、膈神经刺激、左心室电极起搏阈值高、电极脱位等技术难点。另外，多年来研究发现约30%～40%患者BiVP-CRT术后心功能无显著改善，即CRT无反应。希浦系统起搏是近年来的研究热点，包括希氏束起搏（HBP）和左束支区域起搏（LBBAP）。HBP是目前最生理性的起搏技术，但由于希氏束解剖位置特点以及起搏电极和工具的限制，HBP的临床应用很难普及。LBBAP是国内原创的生理性起搏新术式，能够克服HBP的临床应用限制，获得HBP相似的生理性起搏效果。LBBAP根据有无左束支夺获进一步分为左束支起搏（LBBP）和左室间隔部起搏（LVSP）,2种起搏术式均可以纠正左束支传导阻滞，缩窄QRS波。LBBAP起搏参数稳定可靠，远期失夺获风险小，展现了巨大的临床应用潜力，具备良好的临床应用前景，有望在未来成为应用最为广泛的生理性起搏技术。但是，目前仍缺乏大规模、多中心的随机对照研究证实LBBAP应用于心力衰竭患者进行再同步治疗的可行性和有效性。在临床实践中，BiVP、HBP、LBBAP 3种生理性起搏策略各有优势和不足，互为补充，对于不同临床特征的心力衰竭患者需选择不同的起搏治疗策略，以期提高心力衰竭患者接受CRT的反应率并改善临床预后。

关键词(KeyWords)： 双心室起搏;希氏束起搏;左束支区域起搏;心脏再同步化治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（81970284）;; CSC临床研究专项基金项目（CSCF2020A01）

作者(Author): 樊晓寒,朱浩杰

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