Lu Wenzhao, Lin Jinxuan, Dai Yan, Chen Keping, Zhang Shu
State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
Heart Fail Rev. 2022 Mar;27(2):507-516. doi: 10.1007/s10741-021-10091-z. Epub 2021 Feb 27.
Pacing-induced cardiomyopathy (PICM) or heart failure accompanied with chronic right ventricular pacing (CRVP-HF) has no established treatments. We aimed to carry out a meta-analysis of published studies about the therapeutic effects of the upgrade to cardiac resynchronization therapy (CRT) in patients of PICM/CRVP-HF. The PUBMED, EMBASE, MEDLINE, OVID databases, and Cochrane Library were systemically searched for relevant publications. Data about the improvements of left ventricular ejection fraction (LVEF), NYHA functional class (NYHA-FC), and the CRT response rate was extracted and synthesized. Mean difference (MD), odds ratio, and standard mean difference (SMD) with 95% confidence interval (CI) were calculated as the effect size by both fixed and random effect models. We included sixteen studies (four about PICM and twelve about CRVP-HF). The total sample size of PICM/CRVP-HF patients was 924. Upgrade to CRT improved the LVEF by 10.87% (95%CI, 8.90 to 12.84%) and reduce the NYHA-FC by around one class (MD, -1.25; 95%CI, -1.43 to -1.06) in PICM/CRVP-HF patients overall. Upgrade to CRT seemed to improve LVEF no less than de-novo CRT (SMD 0.24; 95%CI 0.05 to 0.43; P < 0.05). This meta-analysis suggested that upgrade CRT could improve the cardiac function in PICM/CRVP-HF patients. This strategy may be considered in these patients but require more evidence about the efficacy and procedure-related complications from prospective studies or randomized controlled trials.
起搏诱导性心肌病（PICM）或伴有慢性右心室起搏的心力衰竭（CRVP-HF）尚无既定的治疗方法。我们旨在对已发表的关于升级为心脏再同步治疗（CRT）对PICM/CRVP-HF患者治疗效果的研究进行荟萃分析。系统检索了PUBMED、EMBASE、MEDLINE、OVID数据库和Cochrane图书馆以获取相关出版物。提取并综合了有关左心室射血分数（LVEF）改善、纽约心脏协会功能分级（NYHA-FC）以及CRT反应率的数据。采用固定效应模型和随机效应模型计算平均差（MD）、比值比和95%置信区间（CI）的标准平均差（SMD）作为效应量。我们纳入了16项研究（4项关于PICM，12项关于CRVP-HF）。PICM/CRVP-HF患者的总样本量为924例。总体而言，升级为CRT可使PICM/CRVP-HF患者的LVEF提高10.87%（95%CI，8.90%至12.84%），并使NYHA-FC降低约一级（MD，-1.25；95%CI，-1.43至-1.06）。升级为CRT似乎在改善LVEF方面不低于初次CRT（SMD 0.24；95%CI 0.05至0.43；P<0.05）。这项荟萃分析表明，升级CRT可改善PICM/CRVP-HF患者的心脏功能。对于这些患者可以考虑这一策略，但需要前瞻性研究或随机对照试验提供更多关于疗效和与手术相关并发症的证据。
