升级为希氏-浦肯野系统起搏对起搏诱导性心肌病患者的有益影响：系统评价和荟萃分析。
Beneficial effects of upgrading to His-Purkinje system pacing in patients with pacing-induced cardiomyopathy: a systematic review and meta-analysis.
机构信息
Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Cardiology, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China.
出版信息
PeerJ. 2023 Oct 11;11:e16268. doi: 10.7717/peerj.16268. eCollection 2023.
BACKGROUND
The purpose of this study was to evaluate the effectiveness of His-Purkinje system pacing (HPSP) in the management of patients with pace-induced cardiomyopathy (PICM).
METHODS
PubMed, Embase, Web of Science, and the Cochrane Library were searched comprehensively to collect related studies published from the inception of databases to June 1, 2022. R 4.04 software, including the Metafor package, matrix package, and the Meta package, was utilized to conduct the singe-arm meta-analysis. The methodology index for non-randomized studies (MINORS) was used to assess the methodological quality of the included studies.
RESULTS
A total of seven studies were included, involving 164 PICM patients. The meta-analysis showed that HPSP ameliorated the left ventricular ejection fraction (LVEF) by 13.41% (95% CI [11.21-15.61]), improved the New York Heart Association (NYHA) classification by 1.02 (95% CI [-1.41 to -0.63]), and shortened the QRS duration (QRSd) by 60.85 ms (95% CI [-63.94 to -57.75]), resulting in improved cardiac functions in PICM patients. Besides, HPSP reversed the ventricular remodeling, with a 32.46 ml (95% CI [-53.18 to -11.75]) decrease in left ventricular end systolic volume (LVESV) and a 5.93 mm (95% CI [-7.68 to -4.19]) decrease in left ventricular end-diastolic dimension (LVEDD). HPSP also showed stable electrical parameters of pacemakers, with a 0.07 V (95% CI [0.01-0.13]) increase in pacing threshold, a 0.02 mV (95% CI [-0.85 to 0.90]) increase in sensed R-wave amplitude, and a 31.12 Ω reduction in impedance (95% CI [-69.62 to 7.39]). Compared with LBBP, HBP improved LVEF by 13.28% (95% CI [-11.64 to 14.92]) 14.43% (95% CI [-13.01 to 15.85]), ameliorated NHYA classification by 1.18 (95% CI [-1.97 to -0.39]) 0.95 (95% CI [-1.33 to -0.58]), shortened QRSd by 63.16 ms (95% CI [-67.00 to -59.32]) 57.98 ms (95% CI [-62.52 to -53.25]), and decreased LVEDD by 4.12 mm (95% CI [-5.79 to -2.45]) 6.26 mm (95% CI [-62.52 to -53.25]). The electrical parameters of the pacemaker were stable in both groups.
CONCLUSIONS
This meta-analysis showed that HPSP could significantly improve cardiac function, promote reverse remodeling, and provide stable electrical parameters of pacemakers for PICM patients.
背景
本研究旨在评估希氏-浦肯野系统起搏（HPSP）在起搏诱导性心肌病（PICM）患者管理中的有效性。
方法
全面检索 PubMed、Embase、Web of Science 和 Cochrane Library 数据库，收集从数据库建立到 2022 年 6 月 1 日发表的相关研究。使用 R 4.04 软件，包括 Metafor 包、matrix 包和 Meta 包，进行单臂荟萃分析。使用非随机研究方法学指数（MINORS）评估纳入研究的方法学质量。
结果
共纳入 7 项研究，涉及 164 例 PICM 患者。荟萃分析显示，HPSP 可使左心室射血分数（LVEF）提高 13.41%（95%CI [11.21-15.61]），纽约心脏协会（NYHA）分级提高 1.02（95%CI [-1.41 至-0.63]），QRS 波群持续时间（QRSd）缩短 60.85ms（95%CI [-63.94 至-57.75]），从而改善 PICM 患者的心功能。此外，HPSP 逆转心室重构，左心室收缩末期容积（LVESV）减少 32.46ml（95%CI [-53.18 至-11.75]），左心室舒张末期内径（LVEDD）减少 5.93mm（95%CI [-7.68 至-4.19]）。HPSP 还显示起搏器的电参数稳定，起搏阈值增加 0.07V（95%CI [0.01-0.13]），感知 R 波振幅增加 0.02mV（95%CI [-0.85 至 0.90]），阻抗降低 31.12Ω（95%CI [-69.62 至 7.39]）。与左束支起搏（LBBP）相比，HBP 使 LVEF 提高 13.28%（95%CI [11.64 至 14.92]）和 14.43%（95%CI [13.01 至 15.85]），改善 NYHA 分级 1.18（95%CI [-1.97 至-0.39]）和 0.95（95%CI [-1.33 至-0.58]），缩短 QRSd 63.16ms（95%CI [-67.00 至-59.32]）和 57.98ms（95%CI [-62.52 至-53.25]），减少 LVEDD 4.12mm（95%CI [-5.79 至-2.45]）和 6.26mm（95%CI [-62.52 至-53.25]）。两组起搏器的电参数均稳定。
结论
这项荟萃分析表明，HPSP 可显著改善 PICM 患者的心功能，促进逆向重构，并为其提供稳定的起搏器电参数。
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