Clinical Research Progress Of His Bundle Pacing

At present,right ventricular apex pacing is the most widely used pacing site in clinical application.A large number of studies have confirmed that long-term right ventricular apex pacing changes the order of ventricular physiological activation and increases the risk of clinical adverse events such as heart failure,atrial fibrillation and even death after pacemaker implantation.Whether pacing at other right ventricular replacement sites,such as right ventricular septal pacing,is superior to right ventricular apical pacing,has not been uniformly concluded.On the other hand,for patients with systolic dysfunction and asynchronism of ventricular conduction,cardiac resynchronization therapy with biventricular pacing has become an important treatment method,but there are still some patients who do not respond.Therefore,finding a better pacing site has always been a research hotspot in the field of cardiac pacing.As the most physiological part of ventricular pacing,His bundle pacing can theoretically avoid the asynchronism of the chambers caused by traditional pacing mode and reduce the adverse clinical events such as pacemaker-related heart failure.In recent years,with the development ofpacemaker implantation technology,the success rate of pacemaker implantation has been increasing,and many high-quality clinical studies have emerged.This paper reviews the anatomical physiology of the Hi bundle and summarizes the latest clinical studies of the His bundle pacing,in order to clarify the definition and classification of the His bundle pacing,summarize the indications of it,evaluate the safety and effectiveness of the His bundle pacing,compare the advantages and disadvantages with the traditional right ventricular pacing,explore the possibilities of alternative treatment for cardiac resynchronization unresponsive patients.Finally,the following conclusions are drawn.Current studies have shown that compared with the traditional right ventricular pacing,His bundle pacing can reduce the deterioration of cardiac function and the occurrence of adverse clinical events after pacemaker surgery.For the CRT treatment of traditional biventricular pacing,His bundle pacing can be used as an alternative treatment for failed or unresponsive patients.At the same time,His bundle pacing has some limitations,such as difficult implantation,high pacing threshold and easy occurrence of atrial hypersensitivity.There is still a lack of more large-scale randomized clinical studies to assess the rationality and long-term clinical benefits of His bundle pacing.