心内膜左心室起搏的系统评价。

A systemic review of endocardial left ventricular pacing.

作者信息

Santos Helder, Santos Mariana, Almeida Inês, Paula Sofia B, Figueiredo Margarida, Portugal Guilherme, Valente Bruno, Silva Cunha Pedro, Almeida Lurdes, Oliveira Mário

机构信息

Centro Hospitalar Barreiro-Montijo EPE, Serviço de Cardiology, Barreiro, Portugal.

出版信息

Heart Lung. 2022 Jan-Feb;51:82-86. doi: 10.1016/j.hrtlng.2021.10.003. Epub 2021 Nov 11.

DOI:10.1016/j.hrtlng.2021.10.003

PMID:34775159

Abstract

BACKGROUND

Endocardial left ventricular pacing is an alternative technique used in cardiac resynchronization therapy (CRT), when placement of a left ventricular lead is not possible via the coronary sinus or in non-responders to conventional CRT.

OBJECTIVES

To review the evidence regarding the efficacy and safety of endocardial left ventricular pacing.

METHODS

Systematic research on Medline (PubMed), ClinicalTrials.gov and Embase with the terms "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing" was performed with the identification of 1038 results. Eleven studies with endocardial left ventricular pacing patients were included, independent of the technique being applied to naïve CRT patients or con non-responders to conventional CRT. The end-point of this analysis was the impact of endocardial left ventricular pacing techniques regarding New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width, and the occurrence of complications Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

RESULTS

A total of 560 patients were included, with different techniques used (trans-atrial septal technique, trans-ventricular septal technique and transapical technique). Significant improvement was registered in NYHA class (MD 0.73, CI 0.48-0.98, p<0.00001, I = 87%), LVEF (MD -7.63, CI -9.93 - -5.33, p<0.00001, I = 69%) and QRS width (MD 29.25, CI 9.99-48.50, p<0.00001, I = 91%). Several complications were reported after the procedure, 11 pocket infections, 22 transient ischemic attacks, 18 ischemic strokes, 41 thromboembolic events, among other complications. The mortality rate during the follow-up was 20.54%.

CONCLUSION

Left ventricular endocardial pacing is a feasible alternative to conventional CRT, with clinical, electrocardiographic and echocardiogrphic improvement. However, first data regarding this procedure was associated with significant complications rates.

摘要

背景

当无法经冠状窦放置左心室导线或常规心脏再同步治疗（CRT）无反应时，心内膜左心室起搏是CRT中使用的一种替代技术。

目的

综述有关心内膜左心室起搏疗效和安全性的证据。

方法

在Medline（PubMed）、ClinicalTrials.gov和Embase上进行系统检索，检索词为“心内膜左心室起搏”“双心室起搏”或“心内膜左起搏”，共识别出1038条结果。纳入了11项有关心内膜左心室起搏患者的研究，无论该技术应用于初治CRT患者还是常规CRT无反应者。该分析的终点是心内膜左心室起搏技术对纽约心脏协会（NYHA）功能分级、左心室射血分数（LVEF）和QRS波宽度的影响，以及并发症的发生情况。采用平均差（MD）和置信区间（CI）作为治疗效果的衡量指标。

结果

共纳入560例患者，采用了不同的技术（经房间隔技术、经室间隔技术和经心尖技术）。NYHA分级（MD 0.73，CI 0.48 - 0.98，p<0.00001，I² = 87%）、LVEF（MD -7.63，CI -9.93 - -5.33，p<0.00001，I² = 69%）和QRS波宽度（MD 29.25，CI 9.99 - 48.50，p<0.00001，I² = 91%）均有显著改善。术后报告了多种并发症，包括11例囊袋感染、22例短暂性脑缺血发作、1例缺血性中风、41例血栓栓塞事件等。随访期间的死亡率为20.54%。