Xu Liang, Que Dongdong, Yu Wenjie, Yan Jing, Zhang Xiuli, Wang Yuxi, Yang Yashu, Liang Miaoyuan, Zhang Ronghua, Song Xudong, Yang Pingzhen
Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Heart Center of Zhujiang Hospital, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, Guangdong, China.
Expert Rev Med Devices. 2024 Nov;21(11):1039-1047. doi: 10.1080/17434440.2024.2402561. Epub 2024 Sep 13.
His bundle pacing (HBP) could replace failed biventricular pacing (BVP) in guidelines (IIa Indication), but the high capture thresholds and backup lead pacing requirements limit its development. We assessed the efficacy and safety of HBP combined with atrioventricular node ablation (AVNA) for atrial fibrillation (AF) and compared with BVP and left bundle branch pacing (LBBP).
We reviewed PubMed, Embase, Web of Science, and Cochrane Library databases on left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) score, QRS duration (QRSd), and pacing threshold.
Thirteen studies included 1115 patients (639 with HBP, 338 with BVP, and 221 with LBBP). Compared with baseline, HBP improved LVEF (mean difference [MD]: 9.24 [6.10, 12.37]; < 0.01), reduced NYHA score (MD: -1.12 [-1.34, -0.91]; < 0.01), increased QRSd (MD: 10.08 [4.45, 15.70]; < 0.01), and rose pacing threshold (MD: 0.16 [0.05, 0.26]; < 0.01). HBP had comparable efficacy to BVP and LBBP and lower QRSd ( < 0.05). HBP had a lower success rate (85.97%) and more complications (16.1%).
HBP combined with AVNA is effective for AF, despite having a lower success rate and more complications. Further trials are required to determine whether HBP is superior to BVP and LBBP.
希氏束起搏（HBP）在指南中可替代失败的双心室起搏（BVP）（IIa类推荐），但高夺获阈值和备用导线起搏要求限制了其发展。我们评估了HBP联合房室结消融（AVNA）治疗心房颤动（AF）的疗效和安全性，并与BVP和左束支起搏（LBBP）进行比较。
我们检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库，获取有关左心室射血分数（LVEF）、纽约心脏协会（NYHA）心功能分级、QRS波时限（QRSd）和起搏阈值的信息。
13项研究纳入了1115例患者（639例接受HBP，338例接受BVP，221例接受LBBP）。与基线相比，HBP改善了LVEF（平均差值[MD]：9.24[6.10，12.37]；P<0.01），降低了NYHA心功能分级（MD：-1.12[-1.34，-0.91]；P<0.01），增加了QRSd（MD：10.08[4.45，15.70]；P<0.01），并提高了起搏阈值（MD：0.16[0.05，0.26]；P<0.01）。HBP与BVP和LBBP疗效相当，但QRSd更低（P<0.05）。HBP成功率较低（85.97%），并发症较多（16.1%）。
HBP联合AVNA治疗AF有效，尽管成功率较低且并发症较多。需要进一步试验以确定HBP是否优于BVP和LBBP。
