Garg Jalaj, Chaudhary Rahul, Shah Neeraj, Palaniswamy Chandrasekar, Bozorgnia Babak, Nazir Talha, Natale Andrea, Kutyifa Valentina
Division of Cardiology, Lehigh Valley Health Network, Allentown, PA.
Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD.
J Electrocardiol. 2017 Sep-Oct;50(5):591-597. doi: 10.1016/j.jelectrocard.2017.05.003. Epub 2017 May 18.
We aimed to study the effect of right ventricular implantable cardioverter defibrillator (ICD) lead positioning on clinical outcomes in patients undergoing ICD placement.
A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify clinical trials comparing outcomes in patients with ICD leads in apical and non-apical positions. The primary outcome of our study was death at 1-year follow-up. Secondary outcomes studied were "death at 3years", "total number of shocks", "appropriate shocks", "inappropriate shocks" and "cut-to-suture time".
We analyzed a total of 3731 patients (2852 in apical and 879 in non-apical ICD groups) enrolled in 4 clinical trials. No significant difference was observed between the apical and non-apical ICD groups in all-cause mortality at 1year (OR 0.88; 95% CI 0.51-1.49, p=0.63; I=5.32%). Similarly, no differences were seen between the two groups in death at 3years (OR=0.76; 95% CI 0.56-1.04, p=0.08; I=0%), total number of shocks (OR 0.99; 95% CI 0.81-1.22, p=0.95; I=0%), appropriate shocks (OR 1.00; 95% CI 0.79-1.27, p=0.99; I=0%), inappropriate shocks (OR 0.98; 95% CI 0.70-1.37, p=0.91; I=0%) and cut-to-suture time (Standard mean difference=-0.03; 95% CI -0.20 to 0.14, p=0.73; I=0%). No publication bias was seen.
Non-apical RV ICD lead implantation is non-inferior to traditional RV apical position with no significant differences in mortality, total number of shocks, appropriate shocks, inappropriate shocks and procedural time.
我们旨在研究右心室植入式心律转复除颤器（ICD）导线位置对接受ICD植入患者临床结局的影响。
使用PubMed、EMBASE、科学网和Cochrane对照试验中心注册库进行系统文献检索，以确定比较ICD导线位于心尖和非心尖位置患者结局的临床试验。我们研究的主要结局是1年随访时的死亡。研究的次要结局包括“3年时的死亡”、“电击总数”、“恰当电击”、“不恰当电击”和“切开至缝合时间”。
我们分析了4项临床试验中共3731例患者（心尖ICD组2852例，非心尖ICD组879例）。心尖和非心尖ICD组在1年全因死亡率方面无显著差异（比值比0.88；95%置信区间0.51 - 1.49，p = 0.63；I² = 5.32%）。同样，两组在3年时的死亡（比值比 = 0.76；95%置信区间0.56 - 1.04，p = 0.08；I² = 0%）、电击总数（比值比0.99；95%置信区间0.81 - 1.22，p = 0.95；I² = 0%）、恰当电击（比值比1.00；95%置信区间0.79 - 1.27，p = 0.99；I² = 0%）、不恰当电击（比值比0.98；95%置信区间0.70 - 1.37，p = 0.91；I² = 0%）和切开至缝合时间（标准化均数差 = -0.03；95%置信区间 -0.20至0.14，p = 0.73；I² = 0%）方面均无差异。未发现发表偏倚。
非心尖右心室ICD导线植入不劣于传统的心尖右心室位置，在死亡率、电击总数、恰当电击、不恰当电击和手术时间方面无显著差异。
