Abstract：
Cardiac resynchronization therapy (CRT) is the therapy of choice for patients with symptomatic systolic heart failure (HF) and left bundle branch block (LBBB), despite optimal medical therapy (OMT). The recently published 2021 European Society of Cardiology (ESC) Guidelines on cardiac pacing and cardiac resynchronization therapy highlight the importance of CRT on top of OMT in HF patients with left ventricular ejection fraction (LVEF) ≤ 35%, sinus rhythm and typical LBBB with QRS duration ≥ 150 ms. In the presence of medically intractable or recurrent after catheter ablation atrial fibrillation (AF), AV nodal ablation as an adjuvant therapy becomes more relevant in patients qualifying for the implantation of a biventricular system. Furthermore, CRT may be considered in cases when increased pacing of the right ventricle is not desirable. However, alternative pacing sites and strategies are currently available, if the CRT is not feasible and effective in patients. However, strategies targeting \"multi-sides\" or using \"multi-leads\" have shown superiority over classic CRT. On the other hand, conduction system pacing seems to be a promising technique. Although early results are positive, consistency during the long term is pending. The indication for additional defibrillation therapy (ICD) may occasionally be unnecessary and has to be considered individually. Due to the great development and success of heart failure drug therapy, its positive effect on LV function can lead to enormous improvement. Physicians must await these effects and findings, which hopefully could lead to a relevant LV improvement resulting in a definitive decision against an ICD.
摘要：
心脏再同步化治疗（CRT）是有症状的收缩性心力衰竭（HF）和左束支传导阻滞（LBBB）患者的首选治疗方法，尽管最佳药物治疗(OMT)。最近发布的2021年欧洲心脏病学会（ESC）心脏起搏和心脏再同步治疗指南强调了在左心室射血分数（LVEF）≤35％的HF患者中，在OMT之上使用CRT的重要性。窦性心律和典型的LBBB，QRS持续时间≥150ms。在导管消融术后出现难以治疗或复发的心房颤动(AF)时,房室结消融作为辅助治疗在有资格植入双心室系统的患者中变得更加重要。此外，在不需要增加右心室起搏的情况下，可以考虑CRT。然而,替代起搏部位和策略目前可用，如果CRT对患者不可行和有效。然而,针对“多边”或使用“多引线”的策略显示出比经典CRT的优越性。另一方面,传导系统起搏似乎是一种有前途的技术。尽管早期结果是积极的，长期的一致性有待解决。额外除颤治疗(ICD)的指征有时可能是不必要的,并且必须单独考虑。由于心力衰竭药物治疗的巨大发展和成功，它对LV功能的积极影响可以带来巨大的改善。医生必须等待这些影响和发现，这有望导致相关的LV改善，从而得出针对ICD的最终决定。
