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右室心尖部作为传统的永久心脏起搏器植入位点,主要是因为电极容易放置及电极脱位率低。但是心尖部起搏属非生理性起搏,它使心室除极和机械收缩发生异常,从而导致长期的血流动力学紊乱(心室收缩和舒张异常)和组织结构的改变。随着近年主动固定的螺旋电极及螺旋电极操作手柄的问世,使右室流出道起搏成为可能。大量动物实验和临床研究提示右室流出道靠近房室结、希氏束部位,在此部位起搏心室激动和收缩顺序趋于正常,从而能明显的改善血流动力学指标。目前右室流出道起搏尚处于临床实验阶段,且关于右室流出道解剖位点的确定,适宜患者群的筛选标准、监测和评价指标的选择尚无统一的标准。其长期效果及能否改善患者预后等还有待更深入的研究。现就目前国内外关于右室流出道起搏的研究现状综述如下。
Right ventricular apex as a traditional permanent pacemaker implantation site, mainly because the electrode is easy to place and electrode dislocation rate is low. However, apical pacing is a non-physiological pacing that causes abnormalities in ventricular depolarization and mechanical contractions resulting in long-term hemodynamic disturbances (ventricular systolic and diastolic abnormalities) and changes in tissue structure. With the advent of active fixed helical electrodes and helical electrode operating handles in recent years, it is possible to make right ventricular outflow tract pacing. A large number of animal experiments and clinical studies suggest that right ventricular outflow tract near the atrioventricular node, His bundle beam site, in this part of the ventricular activation and contraction sequence tends to be normal, which can significantly improve hemodynamic indicators. At present, right ventricular outflow tract pacing is still in clinical experimental stage, and on the right ventricular outflow tract anatomical site to determine the appropriate patient group screening criteria, monitoring and evaluation of the choice of indicators there is no uniform standard. Its long-term effect and whether it can improve the prognosis of patients still needs more in-depth study. Now at home and abroad on the right ventricular outflow tract pacing research status are summarized below.