Zhang L, Jiang H, Wang W, Bai J, Liang Y, Su Y, Ge J
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai Medical College of Fudan University, 1069 Xietu Road, 200032, Shanghai, China.
Herz. 2018 Aug;43(5):438-446. doi: 10.1007/s00059-017-4589-7. Epub 2017 Jul 28.
Interatrial septum (IAS) pacing seems to be a promising strategy for the prevention of atrial fibrillation (AF); however, studies have yielded conflicting results. This meta-analysis was to compare IAS with right atrial appendage (RAA) pacing on the prevention of postpacing AF occurrence.
Pubmed, MEDLINE, EMBASE and Web of Science databases were searched through October 2016 for randomized controlled trials comparing IAS with RAA pacing on the prevention of AF. Data concerning study design, patient characteristics and outcomes were extracted. Risk ratio (RR), weighted mean differences (WMD) or standardized mean differences (SMD) were calculated using fixed or random effects models.
A total of 12 trials involving 1146 patients with dual-chamber pacing were included. Although IAS was superior to RAA pacing in terms of reducing the number of AF episodes (SMD = -0.29, P = 0.05), AF burden (SMD = -0.41, P = 0.008) and P -wave duration (WMD = -34.45 ms, P < 0.0001), neither permanent AF occurrence (RR = 0.94, P = 0.58) nor recurrences of AF (RR = 0.88, P = 0.36) were reduced by IAS pacing. Nevertheless, no differences were observed concerning all-cause death (RR = 1.04, P = 0.88), procedure-related events (RR = 1.17, P = 0.69) and pacing parameters between IAS and RAA pacing in the follow-up period.
IAS pacing is safe and as well tolerated as RAA pacing. Although IAS pacing may fail to prevent permanent AF occurrence and recurrences of AF, it is able to not only improve interatrial conduction, but also reduce AF burden.
房间隔（IAS）起搏似乎是预防心房颤动（AF）的一种有前景的策略；然而，研究结果相互矛盾。本荟萃分析旨在比较IAS起搏与右心耳（RAA）起搏在预防起搏后房颤发生方面的效果。
检索了截至2016年10月的Pubmed、MEDLINE、EMBASE和科学网数据库，以查找比较IAS起搏与RAA起搏预防房颤的随机对照试验。提取有关研究设计、患者特征和结局的数据。使用固定或随机效应模型计算风险比（RR）、加权平均差（WMD）或标准化平均差（SMD）。
共纳入12项涉及1146例双腔起搏患者的试验。尽管IAS起搏在减少房颤发作次数（SMD = -0.29，P = 0.05）、房颤负荷（SMD = -0.41，P = 0.008）和P波时限（WMD = -34.45 ms，P < 0.0001）方面优于RAA起搏，但IAS起搏既未降低永久性房颤的发生率（RR = 0.94，P = 0.58），也未降低房颤复发率（RR = 0.88，P = 0.36）。然而，在随访期间，IAS起搏与RAA起搏在全因死亡（RR = 1.04，P = 0.88）、与手术相关的事件（RR = 1.17，P = 0.69）和起搏参数方面未观察到差异。
IAS起搏安全且耐受性与RAA起搏相同。尽管IAS起搏可能无法预防永久性房颤的发生和房颤复发，但它不仅能够改善房间传导，还能减轻房颤负荷。
