无导线起搏器与传统经静脉起搏器植入术后结局的比较：一项最新的荟萃分析。
Comparison of Postoperative Outcomes between Leadless and Conventional Transvenous Pacemakers Implantation: An Up-to-Date Meta-analysis.
作者信息
Dai Huimiao, Liu Hao, Gao Chuncheng, Han Jing, Meng Jun, Liu Pengyun, Zhang Mingming, Li Dongdong, Guo Wangang
机构信息
Department of Cardiology, The Second Affiliated Hospital of Air Force Medical University, 710038 Xi'an, Shaanxi, China.
Xi'an Medical College,710000 Xi'an, Shaanxi, China.
出版信息
Rev Cardiovasc Med. 2024 Oct 9;25(10):359. doi: 10.31083/j.rcm2510359. eCollection 2024 Oct.
BACKGROUND
Leadless cardiac pacemakers (LCPs) are emerging as viable alternatives to conventional transvenous pacemakers (TVPs). This study aimed to systematically compare the postoperative outcomes of LCPs and TVPs based on available published studies.
METHODS
We conducted a systematic review and meta-analysis of literature comparing outcomes from LCP and TVP implantations. Data analysis was performed using Stata/MP 17.0. The evaluated endpoints included pericardial effusion or perforation, puncture site events, infective endocarditis, lead or device dislodgement, pocket-related complications, tricuspid regurgitation or dysfunction, any infection, increased right ventricle (RV) pacing threshold, embolism, and thrombosis. Aggregated odds ratios (OR) and 95% confidence intervals (CI) were determined. Sensitivity analyses were conducted for heterogeneity if I was >50% or < 0.01, otherwise, the random-effects model was chosen. Publication bias was analyzed if the number studies exceeded ten.
RESULTS
The meta-analysis included 24 observational studies with 78,938 patients, comprising 24,191 with LCP implantation and 54,747 with TVP implantation. The results indicated a significantly lower incidence of lead or device dislodgment (OR = 3.32, 95% CI: 1.91-5.77, < 0.01), infective endocarditis (OR = 3.62, 95% CI: 3.10-4.24, < 0.01), and infection (OR = 3.93, 95% CI: 1.67-9.24, < 0.01) in the LCP group compared to the TVP group. In contrast, incidences of puncture site complications (OR = 0.24, 95% CI: 0.19-0.32, 0.01) and pericardial effusion or perforation (OR = 0.33, 95% CI: 0.28-0.39, < 0.01) were significantly higher in the LCP group.
CONCLUSIONS
Compared with TVP, LCP implantation is associated with a lower risk of infective endocarditis, lead or device dislodgment, infections, and pocket-related complications. However, LCP implantation carries a higher risk of puncture site complications and pericardial effusion or perforation. These findings underscore the need for careful consideration of patient-specific factors when choosing between LCP and TVP implantation.
THE PROSPERO REGISTRATION
https://www.crd.york.ac.uk/prospero/ (CRD42023453145).
背景
无导线心脏起搏器（LCP）正在成为传统经静脉起搏器（TVP）的可行替代方案。本研究旨在根据现有已发表的研究系统地比较LCP和TVP的术后结果。
方法
我们对比较LCP和TVP植入结果的文献进行了系统评价和荟萃分析。使用Stata/MP 17.0进行数据分析。评估的终点包括心包积液或穿孔、穿刺部位事件、感染性心内膜炎、导线或装置移位、囊袋相关并发症、三尖瓣反流或功能障碍、任何感染、右心室（RV）起搏阈值升高、栓塞和血栓形成。确定汇总比值比（OR）和95%置信区间（CI）。如果I²>50%或P<0.01，则对异质性进行敏感性分析，否则选择随机效应模型。如果研究数量超过十项，则分析发表偏倚。
结果
荟萃分析纳入了24项观察性研究，共78938例患者，其中24191例植入LCP，54747例植入TVP。结果表明，与TVP组相比，LCP组导线或装置移位（OR = 3.32，95%CI：1.91-5.77，P<0.01）、感染性心内膜炎（OR = 3.62，95%CI：3.10-4.24，P<0.01）和感染（OR = 3.93，95%CI：1.67-9.24，P<0.01）的发生率显著较低。相比之下，LCP组穿刺部位并发症（OR = 0.24，95%CI：0.19-0.32，P<0.01）和心包积液或穿孔（OR = 0.33，95%CI：0.28-0.39，P<0.01）的发生率显著较高。
结论
与TVP相比，植入LCP与感染性心内膜炎、导线或装置移位、感染及囊袋相关并发症的风险较低相关。然而，植入LCP穿刺部位并发症以及心包积液或穿孔的风险较高。这些发现强调了在选择LCP和TVP植入时仔细考虑患者特定因素的必要性。
PROSPERO注册：https://www.crd.york.ac.uk/prospero/（CRD42023453145）。
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