Right ventricular pacing causes electric and mechanical dyssynchrony, which is associated with an increased risk for heart failure and atrial fibrillation. Cardiac resynchronization therapy with biventricular pacing reduces ventricular dyssynchrony and results in clinical benefits in subsets of patients with heart failure with QRS prolongation. Recently, His bundle pacing has increased in use as a physiological pacing modality but is limited by difficult implantation, lower success rates in patients with QRS prolongation, and high, often unstable, pacing capture threshold. Thus, the concept of pacing the conduction system distal to the His bundle to bypass the region of conduction block was proposed. Early clinical studies demonstrated the procedural feasibility of left bundle branch pacing using a transventricular septal approach that generates narrow paced QRS duration, fast synchronized left ventricular activation, and correction of left bundle branch block. The current status and future direction of left bundle branch pacing are summarized in this paper.

中文翻译：

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左束分支起搏

右心室起搏会导致电和机械不同步，这与心力衰竭和心房颤动的风险增加有关。双心室起搏的心脏再同步治疗可减少心室不同步，并为 QRS 延长的心力衰竭患者带来临床益处。最近，His 束起搏作为一种生理起搏方式的使用有所增加，但受到植入困难、QRS 延长患者成功率较低以及起搏捕获阈值高（通常不稳定）的限制。因此，提出了在希氏束远端的传导系统起搏以绕过传导阻滞区域的概念。早期临床研究证明了使用经室间隔入路左束支起搏的程序可行性，该入路产生窄起搏 QRS 持续时间、快速同步左心室激动和纠正左束支传导阻滞。本文总结了左束支起搏的现状和未来发展方向。