Department of Cardiology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
Can J Cardiol. 2013 Jun;29(6):727-33. doi: 10.1016/j.cjca.2012.10.013. Epub 2013 Mar 7.
Although left ventricular pacing (LVP) leads to a greater acute hemodynamic response than does biventricular pacing (BVP), the long-term effects are diverse. We aimed to assess the efficacy of LVP and BVP in patients undergoing cardiac resynchronization therapy and determine which patients would benefit more from LVP or BVP.
Randomized controlled trials that compared left and biventricular pacing were retrieved from MEDLINE and analyzed for changes in cardiac function and dimensions, cardiac resynchronization therapy response, and electromechanical effects.
A total of 811 patients were included from 9 trials. After a mean follow-up, a shorter QRS duration (-40.92 milliseconds; 95% confidence interval [CI], -64.50 to -17.34; P = 0.0007), and improved left ventricular dimensions were observed in the BVP group compared with the LVP group. Moreover, the BVP group had a longer 6-minute hall walk (6MHW) test (37.19 m; 95% CI, 4.72 to 69.67; P = 0.02).
Our results indicate that BVP results in a better electromechanical effect and leads to a better 6MHW test. For all other test criteria, LVP showed a benefit equal to that of BVP. Thus, there is currently insufficient evidence to advocate for LV-only pacing.
虽然左心室起搏（LVP）比双心室起搏（BVP）导致更大的急性血液动力学反应，但长期效果却不同。我们旨在评估心脏再同步治疗中 LVP 和 BVP 的疗效，并确定哪些患者从 LVP 或 BVP 中获益更多。
从 MEDLINE 中检索并分析了比较左心室和双心室起搏的随机对照试验，以评估心功能和心腔大小的变化、心脏再同步治疗反应以及机电效应。
共有 9 项试验纳入了 811 例患者。平均随访后，与 LVP 组相比，BVP 组的 QRS 时限更短（-40.92 毫秒；95%置信区间[CI]，-64.50 至-17.34；P=0.0007），左心室大小也有所改善。此外，BVP 组的 6 分钟步行试验（6MHW）距离更长（37.19 米；95%CI，4.72 至 69.67；P=0.02）。
我们的结果表明，BVP 可产生更好的机电效应，并导致更好的 6MHW 测试。对于所有其他测试标准，LVP 显示出与 BVP 相同的益处。因此，目前尚无足够证据支持仅行左心室起搏。
