Mariani Marco Valerio, Piro Agostino, Forleo Giovanni Battista, Della Rocca Domenico Giovanni, Natale Andrea, Miraldi Fabio, Vizza Carmine Dario, Lavalle Carlo
Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy.
Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy.
Int J Cardiol. 2023 Apr 15;377:52-59. doi: 10.1016/j.ijcard.2023.01.081. Epub 2023 Feb 2.
His- Purkinje system pacing (HPSP) techniques have been proposed as alternative to biventricular pacing (BVP) and right ventricular pacing (RVP).
To compare data regarding clinical, procedural and lead outcomes associated with different pacing techniques.
An accurate search of online scientific libraries (from inception to May, 12,022) was performed. Thirty-three studies were included in the meta-analysis involving 4386 patients, of whom 1324 receiving RVP, 1032 patients receiving BVP, 1069 patients receiving his-bundle pacing (HBP) and 968 patients receiving left bundle branch pacing (LBBP).
LBBP provided a statistically significant increase in LVEF relative to HBP (0.4473 [0.0584; 0.8361] p = 0.0242) and BVP (0.6733 [0.4734; 0.8732] p < 0.0001) in patients with cardiac resynchronization therapy indication. LBBP and HBP significantly decreased QRS duration as compared to BVP, with largest QRS narrowing obtained by LBBP (-0.4951 [-0.9077; -0.0824] p = 0.0187). As compared to LBBP, HBP was associated with a significant increase of pacing threshold (p = 0.0369) and significant reduction of R-wave amplitude over time (p = 0.027). LBBP was associated with significant reduction in RR of hospitalization for HF (HFH) as compared to both BVP (p = 0.0343) and HBP (p = 0.0476), whereas, as compared to RVP, the risk of lead issues was significantly higher with BVP (p = 0.0424) and HBP (p = 0.0298), but not for LBBP (p = 0.425).
As compared to other pacing techniques, LBBP significantly improved LVEF, narrowed QRS duration and reduced HFHs, with steadily lower capture thresholds and higher R-wave amplitude, and without increasing lead issues.
希氏束-浦肯野系统起搏（HPSP）技术已被提议作为双心室起搏（BVP）和右心室起搏（RVP）的替代方法。
比较不同起搏技术相关的临床、操作和导线结局数据。
对在线科学图书馆进行了精确检索（从建库至2022年5月12日）。33项研究纳入荟萃分析，涉及4386例患者，其中1324例接受RVP，1032例接受BVP，1069例接受希氏束起搏（HBP），968例接受左束支起搏（LBBP）。
对于有心脏再同步治疗指征的患者，与HBP（0.4473 [0.0584；0.8361]，p = 0.0242）和BVP（0.6733 [0.4734；0.8732]，p < 0.0001）相比，LBBP使左心室射血分数（LVEF）有统计学意义的升高。与BVP相比，LBBP和HBP显著缩短QRS时限，LBBP使QRS时限缩窄幅度最大（-0.4951 [-0.9077；-0.0824]，p = 0.0187）。与LBBP相比，HBP起搏阈值显著升高（p = 0.0369），随时间推移R波振幅显著降低（p = 0.027）。与BVP（p = 0.0343）和HBP（p = 0.0476）相比，LBBP使因心力衰竭住院率（HFH）显著降低，而与RVP相比，BVP（p = 0.0424）和HBP（p = 0.0298）导线问题风险显著更高，但LBBP无此情况（p = 0.425）。
与其他起搏技术相比，LBBP显著改善LVEF，缩窄QRS时限，降低HFH，起搏阈值稳定降低，R波振幅更高，且不增加导线问题。
