Comparison of Postoperative Outcomes between Leadless and Conventional Transvenous Pacemakers Implantation: An Up-to-Date Meta-analysis.

IF 2.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Reviews in cardiovascular medicine Pub Date : 2024-10-09 eCollection Date: 2024-10-01 DOI:10.31083/j.rcm2510359

Huimiao Dai, Hao Liu, Chuncheng Gao, Jing Han, Jun Meng, Pengyun Liu, Mingming Zhang, Dongdong Li, Wangang Guo

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Abstract

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 I² was >50% or p < 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, p < 0.01), infective endocarditis (OR = 3.62, 95% CI: 3.10-4.24, p < 0.01), and infection (OR = 3.93, 95% CI: 1.67-9.24, p < 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, p < 0.01) and pericardial effusion or perforation (OR = 0.33, 95% CI: 0.28-0.39, p < 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).

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无引线和传统经静脉起搏器植入术的术后效果比较：最新的 Meta 分析。

背景：无引线心脏起搏器（LCP）正在成为传统经静脉起搏器（TVP）的可行替代品。本研究旨在根据已发表的研究结果，系统比较 LCP 和 TVP 的术后效果：我们对比较 LCP 和 TVP 植入术后效果的文献进行了系统回顾和荟萃分析。数据分析使用 Stata/MP 17.0 进行。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、导联或装置脱落、袋相关并发症、三尖瓣反流或功能障碍、任何感染、右心室起搏阈值升高、栓塞和血栓形成。确定了综合几率比（OR）和 95% 置信区间（CI）。如果I2>50%或P<0.01，则进行异质性敏感性分析，否则选择随机效应模型。如果研究数量超过十项，则对发表偏倚进行分析：荟萃分析包括24项观察性研究，共78938名患者，其中24191名患者植入了LCP，54747名患者植入了TVP。结果显示，与 TVP 组相比，LCP 组的导联或装置脱落（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）发生率明显较低。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）的发生率明显更高：结论：与 TVP 相比，LCP 植入术发生感染性心内膜炎、导联或装置脱落、感染和袋相关并发症的风险较低。但是，LCP 植入术发生穿刺部位并发症、心包积液或穿孔的风险较高。这些发现强调，在选择 LCP 还是 TVP 植入术时，需要仔细考虑患者的具体因素。prospero 注册：https://www.crd.york.ac.uk/prospero/ (CRD42023453145)。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.