背景:心脏可植入电子设备(CIED)后三尖瓣反流(TR)和二尖瓣反流(MR)的显着变化日益得到认可。然而,对于右心室起搏(RVP)与经三尖瓣RV导线的ED相关TR和MR的CI风险是否不同,仍然存在不确定性,与心脏再同步治疗(CRT)相比,传导系统起搏(CSP),和无引线起搏(LP)。
目的:综合不同起搏策略的CIED后显著TR和MR风险和预后的现有数据。
方法:我们搜索了PubMed,EMBASE,和Cochrane图书馆数据库发布到10月31日,2023年。CIED后显著TR和MR定义为≥中度。
结果:纳入了57项TR研究(N=13,723例患者)和90项MR研究(N=14,387例患者)。对于所有CIED,CIED后TR的风险增加(合并比值比(OR)=2.46,95%CI=1.88-3.22),而中位随访12个月和6个月后,CIED后MR的风险分别降低(OR=0.74,95%CI=0.58-0.94)。经三尖瓣RV导线的RVP与CIED后TR(OR=4.54,95%CI=3.14-6.57)和CIED后MR(OR=2.24,95%CI=1.18-4.26)的风险增加相关。Binarily,CSP没有改变TR风险(OR=0.37,95%CI=0.13-1.02),但显着降低MR(OR=0.15,95%CI=0.03-0.62)。CRT并没有显著改变TR风险(OR=1.09,95%CI=0.55-2.17),但显着降低MR,CRT前患病率为43%,CRT后降低至22%(OR=0.49,95%CI=0.40-0.61)。LP与CIED后TR(OR=1.15,95%CI=0.83-1.59)或MR(OR=1.31,95%CI=0.72-2.39)没有显着关联。CIED相关TR是中位53个月后全因死亡率的独立预测因素(合并风险比(HR)=1.64,95%CI=1.40-1.90)。CRT后MR持续独立预测38个月后的全因死亡率(HR=2.00,95%CI=1.57-2.55)。
结论:我们的研究结果表明,如果可能,采用避免孤立的经三尖瓣RV导线的起搏策略可能有利于预防房室瓣反流的发生或恶化,并可能降低死亡率.
OBJECTIVE: Significant changes in tricuspid regurgitation (TR) and mitral regurgitation (MR) post-cardiac implantable electronic devices (CIEDs) are increasingly recognized. However, uncertainty remains as to whether the risk of CIED-associated TR and MR differs with right ventricular pacing (RVP) via CIED with trans-tricuspid RV leads, compared with cardiac resynchronization therapy (CRT), conduction system pacing (CSP), and leadless pacing (LP). The study aims to synthesize extant data on risk and prognosis of significant post-CIED TR and MR across pacing strategies.
RESULTS: We searched PubMed, EMBASE, and Cochrane Library databases published until 31 October 2023. Significant post-CIED TR and MR were defined as ≥ moderate. Fifty-seven TR studies (n = 13 723 patients) and 90 MR studies (n = 14 387 patients) were included. For all CIED, the risk of post-CIED TR increased [pooled odds ratio (OR) = 2.46 and 95% CI = 1.88-3.22], while the risk of post-CIED MR reduced (OR = 0.74, 95% CI = 0.58-0.94) after 12 and 6 months of median follow-up, respectively. Right ventricular pacing via CIED with trans-tricuspid RV leads was associated with increased risk of post-CIED TR (OR = 4.54, 95% CI = 3.14-6.57) and post-CIED MR (OR = 2.24, 95% CI = 1.18-4.26). Binarily, CSP did not alter TR risk (OR = 0.37, 95% CI = 0.13-1.02), but significantly reduced MR (OR = 0.15, 95% CI = 0.03-0.62). Cardiac resynchronization therapy did not significantly change TR risk (OR = 1.09, 95% CI = 0.55-2.17), but significantly reduced MR with prevalence pre-CRT of 43%, decreasing post-CRT to 22% (OR = 0.49, 95% CI = 0.40-0.61). There was no significant association of LP with post-CIED TR (OR = 1.15, 95% CI = 0.83-1.59) or MR (OR = 1.31, 95% CI = 0.72-2.39). Cardiac implantable electronic device-associated TR was independently predictive of all-cause mortality [pooled hazard ratio (HR) = 1.64, 95% CI = 1.40-1.90] after median of 53 months. Mitral regurgitation persisting post-CRT independently predicted all-cause mortality (HR = 2.00, 95% CI = 1.57-2.55) after 38 months.
CONCLUSIONS: Our findings suggest that, when possible, adoption of pacing strategies that avoid isolated trans-tricuspid RV leads may be beneficial in preventing incident or deteriorating atrioventricular valvular regurgitation and might reduce mortality.