Outcomes of conduction system pacing compared to right ventricular pacing as a primary strategy for treating bradyarrhythmia: systematic review and meta-analysis

Autor: Chris P Gale, Kevin Vernooy, Christian Meyer, Elena Arbelo, Jens Cosedis Nielsen, Davor Vukadinović, Christian Ukena, Amr Abdin, Suleman Aktaa, Harran Burri, Theresa Munyombwe, Michael Glikson
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Bundle of His
Electrocardiography/methods
Ventricular Function
Left
QRS complex
Electrocardiography
Cardiac Conduction System Disease
ATRIOVENTRICULAR-BLOCK
Internal medicine
Clinical outcomes
Atrial Fibrillation
medicine
Bradycardia
Left bundle branch pacing
Humans
Cardiac Pacing
Artificial/adverse effects
PREDICTORS
INDUCED CARDIOMYOPATHY
Ejection fraction
business.industry
Cardiac Pacing
Artificial
Atrial fibrillation
Stroke Volume
General Medicine
PERFORMANCE
His-bundle pacing
medicine.disease
Confidence interval
Meta-analysis
Treatment Outcome
Stroke Volume/physiology
Heart failure
Relative risk
Cardiac Conduction System Disease/therapy
Cardiology
Systematic review
Electrical conduction system of the heart
Ventricular Function
Left/physiology
Cardiology and Cardiovascular Medicine
business
Cardiac pacing
Atrioventricular block
His‐bundle pacing
Bradycardia/therapy
Zdroj: Abdin, A, Aktaa, S, Vukadinović, D, Arbelo, E, Burri, H, Glikson, M, Meyer, C, Munyombwe, T, Nielsen, J C, Ukena, C, Vernooy, K & Gale, C P 2022, ' Outcomes of conduction system pacing compared to right ventricular pacing as a primary strategy for treating bradyarrhythmia : systematic review and meta-analysis ', Clinical Research in Cardiology, vol. 111, no. 11, pp. 1198-1209 . https://doi.org/10.1007/s00392-021-01927-7
ISSN: 1861-0692
DOI: 10.1007/s00392-021-01927-7
Popis: Background Right ventricular pacing (RVP) may cause electrical and mechanical desynchrony leading to impaired left ventricular ejection fraction (LVEF). We investigated the outcomes of RVP with His bundle pacing (HBP) and left bundle branch pacing (LBBP) for patients requiring a de novo permanent pacemaker (PPM) for bradyarrhythmia. Methods and results Systematic review of randomized clinical trials and observational studies comparing HBP or LBP with RVP for de novo PPM implantation between 01 January 2013 and 17 November 2020 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included all-cause mortality, heart failure hospitalization (HFH), LVEF, QRS duration, lead revision, atrial fibrillation, procedure parameters, and pacing metrics. Overall, 9 studies were included (6 observational, 3 randomised). HBP compared with RVP was associated with decreased HFH (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.49–0.94), preservation of LVEF (mean difference [MD] 0.81, 95% CI − 1.23 to 2.85 vs. − 5.72, 95% CI − 7.64 to -3.79), increased procedure duration (MD 15.17 min, 95% CI 11.30–19.04), and increased lead revisions (RR 5.83, 95% CI 2.17–15.70, p = 0.0005). LBBP compared with RVP was associated with shorter paced QRS durations (MD 5.6 ms, 95% CI − 6.4 to 17.6) vs. (51.0 ms, 95% CI 39.2–62.9) and increased procedure duration (MD 37.78 min, 95% CI 20.04–55.51). Conclusion Of the limited studies published, this meta-analysis found that HBP and LBBP were superior to RVP in maintaining physiological ventricular activation as an initial pacing strategy.
Databáze: OpenAIRE
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