Meta-analysis of clinical outcomes in cardiac resynchronisation therapy: his bundle pacing vs biventricular pacing.

IF 2.9 3区医学 Q3 ENGINEERING, BIOMEDICAL Expert Review of Medical Devices Pub Date : 2023-06-01 DOI:10.1080/17434440.2023.2202816

Antonio da Silva Menezes Junior, Maria Gabriella Zordan Melo, Lara Pedriel Barreto

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Abstract

Introduction and objective: Cardiac resynchronization may treat severe heart failure (HF) with pharmacological optimization, left branch block, and an ejection fraction<35%. However, 30-40% of patients fail therapy. HBP could replace biventricular pacing (BiV). We compared the effectiveness of HBP versus BiV in HF patients.

Methods: We searched PubMed, Embase, and Cochrane for studies on QRS, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, left ventricular end-systolic volume (LVESV), and 6-minute walk test.

Results: Six publications included 774 patients (mean [± standard deviation] age: 66.9 [14.0] years; 484 (62.5%) were males; 408 [52.71%] underwent HBP; the mean follow-up was 6-12 months. The HBP group had a higher QRS reduction in the meta-analysis (median: -17.54 [-20.46, -14.62]; I² = 89%). LVEF showed a median of 8.48 (7.55, 9.41) and I² of 98%, with a higher mean in HBP. The LVESV median was -18.89 (-30.03, -7.75) and I² was 0%, and the HBP group had a lower mean. HBP had a lower NYHA functional class (median= -0.20 [-0.28, -0.12]).

Conclusion: After implantation, HBP demonstrated bigger QRS shortening, increased LVEF, lower LVES volume, and lower NYHA class than BiV pacing.

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心脏再同步化治疗的临床结果荟萃分析:他束起搏vs双心室起搏。

简介和目的:心脏再同步化可以通过药物优化、左支阻滞和射血分数治疗严重心力衰竭(HF)。方法:我们检索PubMed、Embase和Cochrane关于QRS、左室射血分数(LVEF)、纽约心脏协会(NYHA)功能分级、左室收缩末期容积(LVESV)和6分钟步行试验的研究。结果:6篇出版物纳入774例患者(平均[±标准差]年龄:66.9[14.0]岁;男性484例(62.5%);408例(52.71%)行HBP检查;平均随访6-12个月。在荟萃分析中，HBP组的QRS降低更高(中位数:-17.54 [-20.46，-14.62];i2 = 89%)。LVEF的中位数为8.48 (7.55,9.41)，I2为98%，HBP的平均值更高。LVESV中位数为-18.89 (-30.03，-7.75)，I2为0%，HBP组的平均值较低。HBP的NYHA功能等级较低(中位数= -0.20[-0.28，-0.12])。结论:与BiV起搏相比，HBP起搏后QRS缩短、LVEF升高、LVES体积减小、NYHA分级降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.