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HIS-Bündel-Stimulation und alternative rechtsventrikuläre Stimulationsorte

His-bundle stimulation and alternative RV stimulation sites

  • BEITRAG ZUM THEMENSCHWERPUNKT
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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

The increasing evidence that right ventricular (RV) apical stimulation is detrimental for cardiac mechanics and increases the risk of new onset heart failure and mortality promotes strategies to avoid ventricular pacing and – if not applicable due to atrioventricular block – stipulates the search for alternative techniques of pacing the heart from the right ventricle. Despite more than 15 years of clinical research it remains unclear whether pacing from the right ventricular outflow tract or septum, dual site RV stimulation or selective pacing of the His bundle results in hemodynamic and prognostic benefit over the traditional method of apical RV pacing. The article reviews pertinent literature and tries to demonstrate pathophysiological mechanisms.

Zusammenfassung

Die zunehmende Erkenntnis, dass apikale rechtsventrikuläre Stimulation sich deletär auf die kardiale Mechanik auswirken und das Risiko von Herzinsuffizienz und Mortalität erhöhen kann, ist Anlass für Vermeidungsstrategien und – wo diese nicht möglich sind – für die Suche nach alternativen, potentiell weniger pathogenen Stimulationstechniken. Trotz mittlerweile mehr als fünfzehnjähriger klinischer Forschung ist weiter unklar, ob die Stimulation im rechtsventrikulären Ausflusstrakt, von septalen Positionen, an mehreren Orten der rechten Kammer gleichzeitig oder direkt am His'schen Bündel hämodynamische und prognostische Vorteile gegenüber der traditionellen apikalen Stimulation bietet. Der Beitrag sichtet die einschlägige Literatur und versucht, die pathophysiologischen Zusammenhänge aufzuzeigen.

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  1. Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kirrbergerstraße, 66424, Homburg, Germany

    G. Fröhlig & M. Kindermann

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  1. G. Fröhlig
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  2. M. Kindermann
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Correspondence to G. Fröhlig.

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Fröhlig, G., Kindermann, M. HIS-Bündel-Stimulation und alternative rechtsventrikuläre Stimulationsorte. Herzschr. Elektrophys. 19, 30–40 (2008). https://doi.org/10.1007/s00399-008-0598-9

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