背景:左束支区域起搏是双心室起搏的替代方案。在这项研究中,我们的目的是总结可行性的现有证据,功效,左束支传导阻滞区起搏(LBBAP)的安全性。
目的:该研究总结了有关可行性的现有证据,功效,左束支传导阻滞区起搏(LBBAP)的安全性。
背景:心脏再同步治疗(CRT)可降低左心室射血分数(LVEF)≤35%并伴有LBBB的心力衰竭(HF)患者的死亡率和住院率。最近,LBBAP已被研究为实现CRT的更生理的替代方案。
方法:搜索PubMed,EMBASE,和Cochrane数据库被用来确定研究LBBAP用于CRT在心力衰竭中的作用的研究。综合荟萃分析版本4用于荟萃回归,以检查导致数据异质性的变量。
结果:18项研究,检查了17项观察性试验和1项随机对照试验(RCT)。共有3906例接受CRT的HF患者(2036例LBBAP与包括1870双心室起搏[BVP])。90.4%的患者成功进行了LBBAP。与基线相比,LBBAP与QRS持续时间减少相关(MD:-47.23ms95%置信区间[CI]:-53.45,-41.01),LVEF的增加(MD:15.22%,95%CI:13.5,16.94),NYHA等级减少(MD:-1.23,95%CI:-1.41,-1.05)。与BVP相比,LBBAP与QRS持续时间显着减少相关(MD:-20.69ms,95%CI:-25.49,-15.88)和LVEF的改善(MD:4.78%,95%CI:3.30,6.10)。此外,与BVP相比,LBBAP与HF住院率(比值比[OR]:0.44,95%CI:0.34,0.56)和全因死亡率(OR:0.67,95%CI:0.52,0.86)显着降低相关。
结论:与BVP相比,LBBAP与心室电同步性改善相关,以及更好的超声心动图和临床结果。
BACKGROUND: Left bundle branch area pacing is an alternative to biventricular pacing. In this study, we aim to summarize the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP).
OBJECTIVE: The study summarizes the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP).
BACKGROUND: Cardiac resynchronization therapy (CRT) reduced mortality and hospitalizations in heart failure (HF) patients with a left ventricular ejection fraction (LVEF) ≤ 35% and concomitant LBBB. Recently LBBAP has been studied as a more physiological alternative to achieve CRT.
METHODS: A search of PubMed, EMBASE, and Cochrane databases were performed to identify studies examining the role of LBBAP for CRT in heart failure. Comprehensive meta-analysis version 4 was used for meta-regression to examine variables that contribute to data heterogeneity.
RESULTS: Eighteen studies, 17 observational and one randomized controlled trial (RCT) were examined. A total of 3906 HF patients who underwent CRT (2036 LBBAP vs. 1870 biventricular pacing [BVP]) were included. LBBAP was performed successfully in 90.4% of patients. Compared to baseline, LBBAP was associated with a reduction in QRS duration (MD: -47.23 ms 95% confidence interval [CI]: -53.45, -41.01), an increase in LVEF (MD: 15.22%, 95% CI: 13.5, 16.94), and a reduction in NYHA class (MD: -1.23, 95% CI: -1.41, -1.05). Compared to BVP, LBBAP was associated with a significant reduction in QRS duration (MD: -20.69 ms, 95% CI: -25.49, -15.88) and improvement in LVEF (MD: 4.78%, 95% CI: 3.30, 6.10). Furthermore, LBBAP was associated with a significant reduction in HF hospitalization (odds ratio [OR]: 0.44, 95% CI: 0.34, 0.56) and all-cause mortality (OR: 0.67, 95% CI: 0.52, 0.86) compared to BVP.
CONCLUSIONS: LBBAP was associated with improved ventricular electrical synchrony compared to BVP, as well as better echocardiographic and clinical outcomes.