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传统的右室心室心尖(RVA)起搏可导致异常的心室去极化,现越来越多的证据表明,RVA起搏对左室功能和结构具有不利的影响,为此,用其他部位来替代RVA起搏已成为热点。本文中,我们回顾了各起搏部位的临床观察,重点关注右室流出道(RVOT)和希氏束起搏。最近发现,在许多对RVOT起搏的近期和中期效果的数据表明,其结果相互矛盾。尽管近期一项荟萃分析提示,RVOT起搏会产生益处,但是其对RVOT的解剖定位并不明确,而且引用的大多数研究方案也不是随机的。我们认为,起搏部位的选择对于减少或解决因长期起搏而带来的问题是有可能的,因而有必要进行前瞻性、大样本、多中心、随机化的对照研究,并长期随访以获得确切的证据。
Conventional right ventricular apex (RVA) pacing can lead to abnormal ventricular depolarization. There is growing evidence that RVA pacing has an adverse effect on left ventricular function and structure, and for this reason, other sites Replacing RVA pacing has become a hot spot. In this article, we review the clinical observations of each pacing site, with a focus on RVOT and His bundle pacing. Recently, data from many recent and mid-term pacing studies of RVOT have shown conflicting results. Although a recent meta-analysis suggests RVOT pacing may be beneficial, its anatomical positioning of the RVOT is not clear and most of the studies cited are not randomized. We believe that the choice of pacing site is likely to reduce or resolve the problems posed by long-term pacing, necessitating prospective, large-sample, multicenter, randomized controlled studies and long-term follow-up to obtain Exact evidence.