Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room E241, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Arrhythmia Services, Cardiology Department, An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Europace. 2017 Feb 1;19(2):282-288. doi: 10.1093/europace/euw221.
Several pacing modalities across multiple manufacturers have been introduced to minimize unnecessary right ventricular pacing. We conducted a meta-analysis to assess whether ventricular pacing reduction modalities (VPRM) influence hard clinical outcomes in comparison to standard dual-chamber pacing (DDD).
An electronic search was performed using Cochrane Central Register, PubMed, Embase, and Scopus. Only randomized controlled trials (RCT) were included in this analysis. Outcomes of interest included: frequency of ventricular pacing (VP), incident persistent/permanent atrial fibrillation (PerAF), all-cause hospitalization and all-cause mortality. Odds ratios (OR) were reported for dichotomous variables. Seven RCTs involving 4119 adult patients were identified. Ventricular pacing reduction modalities were employed in 2069 patients: (MVP, Medtronic Inc.) in 1423 and (SafeR, Sorin CRM, Clamart) in 646 patients. Baseline demographics and clinical characteristics were similar between VPRM and DDD groups. The mean follow-up period was 2.5 ± 0.9 years. Ventricular pacing reduction modalities showed uniform reduction in VP in comparison to DDD groups among all individual studies. The incidence of PerAF was similar between both groups {8 vs. 10%, OR 0.84 [95% confidence interval (CI) 0.57; 1.24], P = 0.38}. Ventricular pacing reduction modalities showed no significant differences in comparison to DDD for all-cause hospitalization or all-cause mortality [9 vs. 11%, OR 0.82 (95% CI 0.65; 1.03), P= 0.09; 6 vs. 6%, OR 0.97 (95% CI 0.74; 1.28), P = 0.84, respectively].
Novel VPRM measures effectively reduce VP in comparison to standard DDD. When actively programmed, VPRM did not improve clinical outcomes and were not superior to standard DDD programming in reducing incidence of PerAF, all-cause hospitalization, or all-cause mortality.
为了尽量减少不必要的右心室起搏，多家制造商推出了多种起搏模式。我们进行了一项荟萃分析，以评估与标准双腔起搏（DDD）相比，心室起搏减少模式（VPRM）是否会影响硬临床结局。
使用 Cochrane 中央注册处、PubMed、Embase 和 Scopus 进行电子检索。本分析仅纳入随机对照试验（RCT）。感兴趣的结局包括：心室起搏（VP）频率、持续性/永久性心房颤动（PerAF）发生率、全因住院和全因死亡率。二分类变量报告比值比（OR）。确定了 7 项涉及 4119 名成年患者的 RCT。在 2069 名患者中使用了心室起搏减少模式：1423 名患者使用 MVP（美敦力公司），646 名患者使用 SafeR（索林 CRM，克拉马）。VPRM 和 DDD 组的基线人口统计学和临床特征相似。平均随访时间为 2.5±0.9 年。与 DDD 组相比，所有单独研究中 VPRM 组的 VP 均呈均匀减少趋势。两组之间 PerAF 的发生率相似[8%比 10%，OR 0.84（95%置信区间 0.57；1.24），P=0.38]。与 DDD 相比，VPRM 组在全因住院或全因死亡率方面无显著差异[9%比 11%，OR 0.82（95%置信区间 0.65；1.03），P=0.09；6%比 6%，OR 0.97（95%置信区间 0.74；1.28），P=0.84]。
与标准 DDD 相比，新型 VPRM 措施可有效减少 VP。当积极程控时，VPRM 并不能改善临床结局，在降低 PerAF、全因住院或全因死亡率方面也不比标准 DDD 程控更有优势。
