His bundle pacing combined with atrioventricular node ablation for atrial fibrillation: a systematic review and meta-analysis.

IF 2.9 3区医学 Q3 ENGINEERING, BIOMEDICAL Expert Review of Medical Devices Pub Date : 2024-09-13 DOI:10.1080/17434440.2024.2402561

Liang Xu,Dongdong Que,Wenjie Yu,Jing Yan,Xiuli Zhang,Yuxi Wang,Yashu Yang,Miaoyuan Liang,Ronghua Zhang,Xudong Song,Pingzhen Yang

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Abstract

INTRODUCTION AND OBJECTIVE 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). METHODS 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. RESULTS 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]; p < 0.01), reduced NYHA score (MD: -1.12 [-1.34, -0.91]; p < 0.01), increased QRSd (MD: 10.08 [4.45, 15.70]; p < 0.01), and rose pacing threshold (MD: 0.16 [0.05, 0.26]; p < 0.01). HBP had comparable efficacy to BVP and LBBP and lower QRSd (p < 0.05). HBP had a lower success rate (85.97%) and more complications (16.1%). CONCLUSION 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.

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他束起搏联合房室结消融治疗心房颤动：系统综述和荟萃分析。

简介和目的在指南（IIa 适应症）中，顺束起搏（HBP）可取代失效的双心室起搏（BVP），但高捕获阈值和备用导联起搏要求限制了其发展。我们评估了 HBP 联合房室结消融术（AVNA）治疗房颤（AF）的有效性和安全性，并与 BVP 和左束支起搏（LBBP）进行了比较。方法我们查阅了 PubMed、Embase、Web of Science 和 Cochrane Library 数据库中有关左室射血分数 (LVEF)、纽约心脏病协会 (NYHA) 评分、QRS 持续时间 (QRSd) 和起搏阈值的内容。结果13 项研究共纳入 1115 名患者（639 名患者接受 HBP，338 名患者接受 BVP，221 名患者接受 LBBP）。与基线相比，HBP 改善了 LVEF（平均差 [MD]：9.24 [6.10，12.37]；P <0.01），降低了 NYHA 评分（MD：-1.12 [-1.34，-0.91]；P <0.01），增加了 QRSd（MD：10.08 [4.45，15.70]；P <0.01），提高了起搏阈值（MD：0.16 [0.05，0.26]；P <0.01）。HBP 的疗效与 BVP 和 LBBP 相当，QRSd 更低（P < 0.05）。结论HBP联合AVNA对房颤有效，尽管成功率较低且并发症较多。需要进一步试验来确定 HBP 是否优于 BVP 和 LBBP。

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来源期刊

Expert Review of Medical Devices 医学-工程：生物医学

CiteScore

5.90

自引率

3.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal serves the device research community by providing a comprehensive body of high-quality information from leading experts, all subject to rigorous peer review. The Expert Review format is specially structured to optimize the value of the information to reader. Comprehensive coverage by each author in a key area of research or clinical practice is augmented by the following sections: Expert commentary - a personal view on the most effective or promising strategies Five-year view - a clear perspective of future prospects within a realistic timescale Key issues - an executive summary cutting to the author''s most critical points In addition to the Review program, each issue also features Medical Device Profiles - objective assessments of specific devices in development or clinical use to help inform clinical practice. There are also Perspectives - overviews highlighting areas of current debate and controversy, together with reports from the conference scene and invited Editorials.