Osiecki Andrzej, Kochman Wacław, Witte Klaus K, Mańczak Małgorzata, Olszewski Robert, Michałkiewicz Dariusz
Department of Cardiovascular Diseases, Bielanski Hospital, Centre of Postgraduate Medical Education, Ceglowska 80 Street, 01-809 Warsaw, Poland.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
J Clin Med. 2022 Nov 22;11(23):6889. doi: 10.3390/jcm11236889.
Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF).
we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model.
14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91).
our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.
缓慢性心律失常是潜在的危及生命的疾病。治疗缓慢心律最常用的方法是人工心室起搏。从人工起搏的想法诞生之初，心室导线就置于右心室心尖部。右心室心尖部起搏（RVAP）被认为会对左心室收缩功能产生不良影响。本研究的目的是系统评估随机对照试验的结果，以确定右心室心尖部起搏对左心室射血分数（LVEF）的影响。
我们系统检索了Cochrane对照试验中心注册库、PubMed和EMBASE数据库，以查找评估RVAP对LVEF影响的研究。采用随机效应模型估计合并平均差（MD）及95%置信区间（CI）。
纳入了14项随机对照试验（RCT），共885例患者。在我们的荟萃分析中，RVAP与LVEF所测量的具有统计学意义的左心室收缩功能损害相关。基线时与干预后LVEF的平均差值为3.35%（95%CI：1.80 - 4.91）。
我们的荟萃分析证实，右心室心尖部起搏与左心室收缩功能的进行性恶化相关。
