希氏-浦肯野系统起搏治疗心房颤动合并心力衰竭患者的安全性和有效性：一项系统评价和荟萃分析。
Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis.
作者信息
Guan Lin, Wang Chuanhe, Guan Xueqing, Cheng Gong, Sun Zhijun
机构信息
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
出版信息
Front Cardiovasc Med. 2023 Sep 13;10:1233694. doi: 10.3389/fcvm.2023.1233694. eCollection 2023.
AIM
To evaluate the safety and efficacy of the His-Purkinje system pacing (HPCSP) in the treatment of individuals with atrial fibrillation (AF) complicated by heart failure (HF).
METHODS
The PubMed, Cochrane Library, Web of Science, and Embase databases were searched through September 1, 2022. The literature was initially screened based on the inclusion and exclusion criteria. The baseline characteristics of the subjects, implantation success rate, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), QRS duration, pacing threshold, and impedance were extracted and summarized; statistical analysis was performed using RevMan 5.3 software.
RESULTS
In all, 22 articles were included, involving 1,445 patients. Compared to biventricular pacing (BiVP), HPCSP resulted in improved cardiac function, including increased ejection fraction (MD = 5.69, 95% CI: 0.78-10.60, = 0.02) and decreased LVEDd (MD = -3.50, 95% CI: -7.05-0.05, = 0.05). It was also correlated with shorter QRS duration (MD = -38.30, 95% CI: -60.71--15.88, < 0.01) and reduced all-cause mortality and rehospitalization events (RR = 0.72, 95% CI: 0.57-0.91, < 0.01) in patients. Left bundle branch pacing (LBBP) lowered the pacing threshold (MD = 0.47; 95% CI: 0.25-0.69; < 0.01), and there was no statistical difference in the rate of endpoint events when comparing these two physiologic pacing modalities (RR = 1.56, 95% CI: 0.87-2.80, = 0.14).
CONCLUSION
The safety and efficacy of HPCSP in patients with AF and HF were verified in this meta-analysis. HPCSP can reverse cardiac remodeling and has great clinical application value. Relatively speaking, His-bundle pacing (HBP) can maintain better ventricular electro-mechanical synchronization, and the pacing parameters of LBBP are more stable.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42022336109).
目的
评估希氏束-浦肯野系统起搏（HPCSP）治疗合并心力衰竭（HF）的心房颤动（AF）患者的安全性和有效性。
方法
检索截至2022年9月1日的PubMed、Cochrane图书馆、Web of Science和Embase数据库。根据纳入和排除标准对文献进行初步筛选。提取并汇总受试者的基线特征、植入成功率、纽约心脏协会（NYHA）分级、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）、QRS波时限、起搏阈值和阻抗；使用RevMan 5.3软件进行统计分析。
结果
共纳入22篇文章，涉及1445例患者。与双心室起搏（BiVP）相比，HPCSP可改善心功能，包括提高射血分数（MD = 5.69，95%CI：0.78 - 10.60，P = 0.02）和减小LVEDd（MD = -3.50，95%CI：-7.05 - 0.05，P = 0.05）。它还与患者较短的QRS波时限（MD = -38.30，95%CI：-60.71 - -15.88，P < 0.01）以及降低全因死亡率和再住院事件相关（RR = 0.72，95%CI：0.57 - 0.91，P < 0.01）。左束支起搏（LBBP）降低了起搏阈值（MD = 0.47；95%CI：0.25 - 0.69；P < 0.01），比较这两种生理性起搏方式时终点事件发生率无统计学差异（RR = 1.56，95%CI：0.87 - 2.80，P = 0.14）。
结论
本荟萃分析验证了HPCSP治疗AF和HF患者的安全性和有效性。HPCSP可逆转心脏重塑，具有较大的临床应用价值。相对而言，希氏束起搏（HBP）可维持更好的心室机电同步性，且LBBP的起搏参数更稳定。
系统评价注册
PROSPERO（CRD42022336109）。
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