Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida.
J Cardiovasc Electrophysiol. 2020 Jun;31(6):1482-1492. doi: 10.1111/jce.14490. Epub 2020 Apr 20.
Although right ventricular pacing (RVP) may impair ventricular function, it is commonly used for advanced atrioventricular block (AVB) and normal or mildly reduced ejection fraction (EF). We aimed to compare His bundle pacing (HBP), biventricular pacing (BiVP), and RVP for advanced AVB in patients with normal or mildly reduced EF.
MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, Scopus, and Web of Science were searched. Outcomes were all-cause death, heart failure hospitalizations (HFH), EF, left ventricular volumes, 6-minute walk test, and QRS duration. HBP or BiVP was compared with RVP. Subsequently, network meta-analysis compared the three pacing options. Our protocol was registered in PROSPERO (CRD42018094132). Six studies compared BiVP and RVP (704 vs 614 patients) and four compared HBP and RVP (463 vs 568 patients). Follow-up was 6 months to 5 years. There was significantly lower mortality and HFH with HBP or BiVP as compared with RVP (odds ratio [OR], 0.66, [0.51-0.85], P = .002; OR, 0.61 [0.45-0.82], P < .001, respectively]. HBP or BiVP also showed significant increase in EF and decrease in QRS duration (mean difference [MD], 5.27 [3.86-6.69], P < .001; MD -42.2 [-51.2 to -33.3], P < .001, respectively). In network meta-analysis, HBP and BiVP were associated with significantly improved survival compared to RVP, with surface under the cumulative ranking curve (SUCRA) probability of 79.4%, 69.4%, and 1.2% for HBP, BiVP, and RVP, respectively. For HFH, SUCRA probability was 91.5%, 57.2%, and 1.3%, respectively.
HBP or BiVP were the superior strategies to reduce all-cause death and HFH for advanced AVB with normal or mildly reduced EF, with no significant difference between BiVP and HBP.
虽然右心室起搏（RVP）可能会损害心室功能，但它常用于治疗晚期房室传导阻滞（AVB）和射血分数正常或轻度降低的患者。我们旨在比较希氏束起搏（HBP）、双心室起搏（BiVP）和 RVP 在射血分数正常或轻度降低的晚期 AVB 患者中的应用。
我们检索了 MEDLINE、Embase、Cochrane 中心数据库、ClinicalTrials.gov、Scopus 和 Web of Science。主要终点为全因死亡、心力衰竭住院（HFH）、射血分数（EF）、左心室容积、6 分钟步行试验和 QRS 持续时间。比较了 HBP 或 BiVP 与 RVP。随后，网状荟萃分析比较了三种起搏选择。我们的方案已在 PROSPERO（CRD42018094132）注册。六项研究比较了 BiVP 和 RVP（704 例与 614 例），四项研究比较了 HBP 和 RVP（463 例与 568 例）。随访时间为 6 个月至 5 年。与 RVP 相比，HBP 或 BiVP 显著降低了死亡率和 HFH（比值比 [OR]，0.66 [0.51-0.85]，P=0.002；OR，0.61 [0.45-0.82]，P<0.001）。HBP 或 BiVP 还显著增加了 EF 值并缩短了 QRS 持续时间（平均差值 [MD]，5.27 [3.86-6.69]，P<0.001；MD-42.2 [-51.2 至-33.3]，P<0.001）。在网状荟萃分析中，与 RVP 相比，HBP 和 BiVP 显著提高了生存率，HBP、BiVP 和 RVP 的累积排序曲线下面积（SUCRA）概率分别为 79.4%、69.4%和 1.2%。对于 HFH，SUCRA 概率分别为 91.5%、57.2%和 1.3%。
在射血分数正常或轻度降低的晚期 AVB 患者中，与 RVP 相比，HBP 或 BiVP 可降低全因死亡和 HFH，BiVP 和 HBP 之间没有显著差异。
