传导系统起搏与右心室起搏患者新发心房颤动的风险：一项荟萃分析。
The Risk of New-Onset Atrial Fibrillation in Patients With Conduction System Pacing Versus Right Ventricular Pacing: A Meta-Analysis.
作者信息
Gao Tingwen, Li Zhaofeng, Li Wei, Wang Xue, Xie Xinxing
机构信息
Department of Cardiology, Rizhao Heart Hospital Qingdao University, 276800 Rizhao, Shandong, China.
出版信息
Rev Cardiovasc Med. 2025 Apr 18;26(4):27921. doi: 10.31083/RCM27921. eCollection 2025 Apr.
BACKGROUND
Prior studies have established the safety and efficacy of conduction system pacing (CSP) in improving echocardiographic parameters and clinical outcomes. This meta-analysis aimed to investigate whether CSP could reduce the occurrence of new-onset atrial fibrillation (AF) in comparison to traditional right ventricular pacing (RVP) therapy.
METHODS
A literature search was performed in PubMed, Embase, and the Cochrane Library to identify relevant clinical studies comparing CSP with RVP from January 2000 to June 2024. The study outcome was new-onset AF after pacemaker implantation. Estimated risk ratios (RR), odds ratio (OR) with 95% confidence intervals (CI) were evaluated.
RESULTS
Our analysis included 8 observational studies comprising a total of 2033 patients. The results indicated that 20% (406/2033) of study patients experienced new-onset AF, and CSP was associated with a significantly lower risk of new-onset AF when compared with RVP (RR: 0.44, 95% CI: 0.36-0.54, < 0.00001, I = 11%; OR: 0.34, 95% CI: 0.27-0.44, < 0.0001, I = 0). In the subgroup analysis, patients with atrioventricular block (AVB) tended to benefit more from CSP than those with sinus node dysfunction (SND) or AVB ( = 0.06 for RR; = 0.12 for OR). Publication bias was observed and confirmed by the Egger's test ( = 0.0125 for RR and 0.0345 for OR). Trim and fill analysis was performed, and the overall summary effect size (RR: 0.51, 95% CI: 0.40-0.64; OR: 0.40, 95% CI: 0.31-0.52) remained significant after adjusting for publication bias.
CONCLUSION
CSP could reduce the occurrence of new-onset AF compared with RVP, and this benefit appeared to be more pronounced in patients with AVB than those with SND or AVB. However, large scale randomized controlled trials are needed to validate our findings.
THE PROSPERO REGISTRATION
Registration number: CRD42024569052; registration date: July 25, 2024; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024569052.
背景
既往研究已证实传导系统起搏（CSP）在改善超声心动图参数和临床结局方面的安全性和有效性。本荟萃分析旨在探讨与传统右心室起搏（RVP）治疗相比，CSP是否能降低新发心房颤动（AF）的发生率。
方法
在PubMed、Embase和Cochrane图书馆进行文献检索，以确定2000年1月至2024年6月期间比较CSP与RVP的相关临床研究。研究结局为起搏器植入后新发AF。评估了估计风险比（RR）、优势比（OR）及95%置信区间（CI）。
结果
我们的分析纳入了8项观察性研究，共2033例患者。结果表明，20%（406/2033）的研究患者发生了新发AF，与RVP相比，CSP发生新发AF的风险显著更低（RR：0.44，95%CI：0.36 - 0.54，P < 0.00001，I² = 11%；OR：0.34，95%CI：0.27 - 0.44，P < 0.0001，I² = 0）。在亚组分析中，房室传导阻滞（AVB）患者比窦房结功能障碍（SND）或AVB患者从CSP中获益更多（RR的P = 0.06；OR的P = 0.12）。通过Egger检验观察并证实了发表偏倚（RR的P = 0.0125，OR的P = 0.0345）。进行了修剪和填充分析，校正发表偏倚后总体汇总效应大小（RR：0.51，95%CI：0.40 - 0.64；OR：0.40，95%CI：0.31 - 0.52）仍然显著。
结论
与RVP相比，CSP可降低新发AF的发生率，且这种益处似乎在AVB患者中比在SND或AVB患者中更明显。然而，需要大规模随机对照试验来验证我们的发现。
PROSPERO注册：注册号：CRD42024569052；注册日期：2024年7月25日；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024569052 。
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