18/07/2026
榮幸受邀為《香港醫學會 持續醫學進修專訊》撰寫一篇關於「傳導系統起搏」的繼續醫學進修文章，該文於2026年5月刊出。
傳統上，右心室起搏一直是心臟起搏器的標準手術方案。然而，長期右心室起搏，改變了心臟正常生理性電流激活的順序，可導致心臟電機不同步、左右心室收縮不同步協調、心臟輸出量下降。長期過多的右心室起搏（如多於20%），可引致左心室收縮功能下降、心臟衰竭，亦會增加心房顫動的風險。 近年，心臟起搏領域已大力發展新的起搏技術—生理性起搏（又稱傳導系統起搏），旨在恢復心臟自然的電傳導路徑。此方法主要針對希氏束或左束支進行精準定位起搏，模擬心臟正常的生理性電傳導路徑。生理性起搏的優點，包括：促進左右心室同步收縮、改善血流動力學並且增強心臟輸出量，從而降低因為過度起搏而引起的心臟衰竭、心功能下降或心房顫動的風險。
生理性起搏，可成為需要起搏器治療合併有高度心室起搏依賴患者的首選起搏方法。對於心臟衰竭或心臟功能下降的起搏器候選患者，生理性起搏更可作為心臟再同步化治療的替代或輔助方案。隨著研究繼續支持生理性起搏的長期功效，生理性起搏很可能會重新定義未來心臟起搏的治療標準。
Traditionally, right heart (ventricular) pacing has been the standard approach for pacemaker implantation. However, long-term right ventricular pacing alters the heart's normal physiological sequence of electrical conduction, potentially leading to electromechanical dyssynchrony, uncoordinated contraction between the left and right heart, and reduced cardiac output. Excessive long-term right ventricular pacing (e.g., exceeding 20%) can result in impaired left heart function, heart failure, and increased risk of atrial fibrillation. In recent years, a new technique known as physiological pacing (also referred to as conduction system pacing) has been developed and refined. It aims to restore the heart's natural electrical conduction. This method involves precise pacing at the His bundle or the left bundle branch (the normal electrical conduction system of the heart), thereby mimicking the heart's normal physiological electrical conduction. The advantages of physiological pacing include promoting synchronous contraction of the left and right heart, improving hemodynamics, and enhancing cardiac output; consequently, it reduces the risks of heart failure, cardiac dysfunction, and atrial fibrillation.
Physiological pacing is emerging as the preferred pacing method for patients requiring pacemaker therapy who are highly dependent on ventricular pacing. For pacemaker candidates with heart failure or impaired cardiac function, physiological pacing can serve as an alternative or adjunct to cardiac resynchronization therapy. As research continues to support the long-term efficacy of physiological pacing, it is likely to redefine the standard of care for cardiac pacing in the future.
#香港醫學會 #持續醫學進修專訊 #心臟起搏器 #生理性起搏 #傳導系統起搏
#心跳過慢 #陳杰醫生 #心臟科醫生
