Sharma Sharan Prakash, Dahal Khagendra, Dominic Paari, Sangha Rajbir S
LRG Healthcare University of New England Laconia NH USA.
Division of Cardiology Louisiana State University Health Science Center Shreveport LA USA.
J Arrhythm. 2018 Mar 13;34(2):185-194. doi: 10.1002/joa3.12041. eCollection 2018 Apr.
Traditionally the right ventricular (RV) pacing lead is placed in the RV apex in cardiac resynchronization therapy (CRT). It is not clear whether nonapical placement of the RV lead is associated with a better response to CRT. We aimed to perform a meta-analysis of all randomized controlled trials (RCTs) that compared apical and nonapical RV lead placement in CRT.
We searched PubMed, EMBASE, Cochrane, Scopus, and relevant references for studies and performed meta-analysis using random effects model. Our main outcome measures were all-cause mortality, composite of death and heart failure hospitalization, improvement in ejection fraction (EF), left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), and adverse events.
Seven RCTs with a total population of 1641 patients (1199 apical and 492 nonapical) were included in our meta-analysis. There was no difference in all-cause mortality (5% vs 4.3%, odds ratio (OR) = 0.86; 95% confidence interval (CI) 0.45-1.64; =.65; = 11%) and a composite of death and heart failure hospitalization (14.2% vs 12.9%, OR= 0.92; 95% CI: 0.61-1.38; .68; = 0) between apical and nonapical groups. No difference in improvement in EF (Weighted mean difference (WMD)= 0.37; 95% CI: -2.75-3.48; .82; = 68%), change in LVEDV (WMD= 3.67; 95% CI: -4.86-12.20; =.40; = 89%) and LVESV (WMD= -1.20; 95% CI: -4.32-1.91; =.45; = 0) were noted between apical and nonapical groups. Proportion of patients achieving >15% improvement in EF was similar in both groups (OR= 0.85; 95% CI: 0.62-1.16; =.31; = 0).
In patients with CRT, nonapical RV pacing is not associated with improved clinical and echocardiographic outcomes compared with RV apical pacing.
在心脏再同步治疗（CRT）中，传统上右心室（RV）起搏导线放置在右心室心尖部。目前尚不清楚右心室导线非心尖部放置是否与CRT更好的反应相关。我们旨在对所有比较CRT中右心室导线心尖部和非心尖部放置的随机对照试验（RCT）进行荟萃分析。
我们检索了PubMed、EMBASE、Cochrane、Scopus及相关参考文献中的研究，并使用随机效应模型进行荟萃分析。我们的主要结局指标为全因死亡率、死亡和心力衰竭住院的复合指标、射血分数（EF）改善情况、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）以及不良事件。
我们的荟萃分析纳入了7项RCT，共1641例患者（1199例心尖部放置，492例非心尖部放置）。心尖部和非心尖部组之间在全因死亡率（5%对4.3%，优势比（OR）=0.86；95%置信区间（CI）0.45 - 1.64；P =.65；I² = 11%）以及死亡和心力衰竭住院的复合指标（14.2%对12.9%，OR = 0.92；95% CI：0.61 - 1.38；P =.68；I² = 0）方面无差异。心尖部和非心尖部组之间在EF改善情况（加权平均差（WMD）= 0.37；95% CI： - 2.75 - 3.48；P =.82；I² = 68%）、LVEDV变化（WMD = 3.67；95% CI： - 4.86 - 12.20；P =.40；I² = 89%）和LVESV（WMD = - 1.20；95% CI： - 4.32 - 1.91；P =.45；I² = 0）方面也无差异。两组中EF改善>15%的患者比例相似（OR = 0.85；95% CI：0.62 - 1.16；P =.31；I² = 0）。
在CRT患者中，与右心室心尖部起搏相比，右心室非心尖部起搏与临床和超声心动图结局改善无关。
