希浦系统起搏对老年起搏诱导性心肌病病人效果的Meta分析

doi:10.3969/j.issn.1003-9198.2024.06.005

摘要/Abstract

摘要： 目的评估右心室起搏后,患起搏诱导性心肌病的老年病人升级至希浦系统起搏的临床疗效和安全性。方法在 PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据库、维普数据库检索希浦系统起搏对起搏诱导性心肌病疗效的相关文献,提取研究中有关临床获益和安全性的数据,在RevMan 5.4软件上进行Meta分析。结果共纳入8篇文献,包括185例病人,升级希浦系统起搏的成功率为95%。Meta 分析结果显示:升级希浦系统起搏后,随访期间病人的左心室射血分数(MD=-11.73, 95%CI:-14.74~-8.72, P<0.01)较升级术前提高,QRS波时限(MD=59.84, 95%CI:55.98~63.70, P<0.01)较升级术前缩短,NYHA心功能分级(MD=1.05, 95%CI: 0.70~1.41, P<0.01)较升级术前明显降低,差异均有统计学意义。起搏阈值(MD=-0.11, 95%CI: -0.24~0.02, P=0.08)和R波振幅(MD=-0.35, 95%CI: -1.94 ~1.24, P=0.66)升级术前后差异无统计学意义。同时研究中观察到2例病人死亡。结论对于老年起搏诱导性心肌病病人,可考虑升级起搏方式为希浦系统起搏,不仅可以纠正长期右心室起搏引起的心脏电不同步和心室重塑,同时也能改善病人的临床心功能并减少手术相关并发症。

关键词: 希浦系统起搏, 希氏束起搏, 左束支起搏, 起搏诱导性心肌病, 老年人, 右心室起搏, Meta分析

Abstract: Objective To evaluate the efficacy and clinical benefit of upgrading to His-Purkinje system conduction system pacing (HPCSP) in the elderly patients with pacing-induced cardiomyopathy (PICM) after right ventricular pacing (RVP). Methods The literatures on Hirsch-Purkinje system (Hirsch-Purkinje system) pacing in the patients with PICM were searched from PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data and VIP Database, based on inclusion and exclusion criteria. The relevant data on clinical efficacy and safety were extracted from the studies, and were analyzed by RevMan 5.4 software. Results A total of 8 literatures were enrolled in this study, and 185 patients were included. The successful rate of HPCSP was 95%. The results of Meta-analysis showed that, compared with baseline, patients’ left ventricular ejection fraction(MD=-11.73, 95%CI:-14.74--8.72, P<0.01)was significantly increased, QRS duration(MD=59.84, 95%CI:55.98-63.70, P<0.01)was shortened, cardiac function classification of New York Heart Association(MD=1.05, 95%CI: 0.70-1.41, P<0.01)was significantly increased. No significant differences were observed in pacing threshold (MD=-0.11, 95%CI: -0.24-0.02, P=0.08) and R-wave(MD=-0.35, 95%CI: -1.94-1.24, P=0.66) before and after the upgrading operation. Conclusions For the elderly patients with PICM, upgrading the pacing mode to HPCSP should be considered. HPCSP can correct electrical dissynchronization and ventricular remodeling caused by long-term right ventricular pacing, and can improve clinical cardiac function and reduce surgery-related complications.

Key words: His-Purkinje conduction system pacing, His bundle pacing, left bundle branch pacing, pacing-induced cardiomyopathy, aged, right ventricular pacing, Meta-analysis

中图分类号:

R541.6

成荣, 周昊阳, 李颖, 张成, 李春雨, 陈彦. 希浦系统起搏对老年起搏诱导性心肌病病人效果的Meta分析[J]. 实用老年医学, 2024, 38(6): 557-563.

CHENG Rong, ZHOU Haoyang, LI Ying, ZHANG Cheng, LI Chunyu, CHEN Yan. A Meta-analysis on the efficacy of His-Purkinje system pacing in elderly patients with pacing-induced cardiomyopathy[J]. Practical Geriatrics, 2024, 38(6): 557-563.

参考文献

[1] MCDONAGH T A, METRA M, ADAMO M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2021, 42(36): 3599-3726.
[2] SWEENEY M O, HELLKAMP A S, ELLENBOGEN K A, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction[J]. Circulation, 2003, 107(23): 2932-2937.
[3] NAKASUKA K, ISHIBASHI K, KAMIJIMA A, et al. Very long-term prognosis in patients with right ventricular apical pacing for sick sinus syndrome[J]. Heart, 2019, 105(19): 1493-1499.
[4] KHURSHID S, EPSTEIN A E, VERDINO R J, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy[J]. Heart Rhythm, 2014, 11(9): 1619-1625.
[5] MERCHANT F M, MITTAL S. Pacing induced cardiomyopathy[J]. J Cardiovasc Electrophysiol, 2020, 31(1): 286-292.
[6] 刘霞. 永久性植入不同类型心脏起搏器对心功能的影响[J]. 实用临床医药杂志, 2019, 23(1): 28-31.
[7] CHO S W, GWAG H B, HWANG J K, et al. Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy[J]. Eur J Heart Fail, 2019, 21(5): 643-651.
[8] TAYAL B, FRUELUND P, SOGAARD P, et al. Incidence of heart failure after pacemaker implantation: a nationwide Danish registry-based follow-up study[J]. Eur Heart J, 2019, 40(44): 3641-3648.
[9] VIJAYARAMAN P, CHUNG M K, DANDAMUDI G, et al. His bundle pacing[J]. J Am Coll Cardiol, 2018, 72(8): 927-947.
[10] SU L, WANG S, WU S, et al. Long-term safety and feasibility of left bundle branch pacing in a large single-center study[J]. Circ Arrhythm Electrophysiol, 2021, 14(2): e009261.
[11] 马裴裴. 希浦系统起搏治疗预防心力衰竭的临床研究[D]. 大连:大连医科大学, 2021.
[12] DESHMUKH P, CASAVANT D A, ROMANYSHYN M, et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation[J]. Circulation, 2000, 101(8): 869-877.
[13] WU S, SU L, VIJAYARAMAN P, et al. Left bundle branch pacing for cardiac resynchronization therapy: nonrandomized on-treatment comparison with His bundle pacing and biventricular pacing[J]. Can J Cardiol, 2021, 37(2): 319-328.
[14] SHARMA P S, NAPERKOWSKI A, BAUCH T D, et al. Permanent His bundle pacing for cardiac resynchronization therapy in patients with heart failure and right bundle branch block[J]. Circ Arrhythm Electrophysiol, 2018, 11(9): e006613.
[15] MORIÑA-VÁZQUEZ P, MORALEDA-SALAS M T, MANOVEL-SÁNCHEZ A J, et al. Early improvement of left ventricular ejection fraction by cardiac resynchronization through His bundle pacing in patients with heart failure[J]. Europace, 2020, 22(1): 125-132.
[16] YE Y, WU S, SU L, et al. Feasibility and outcomes of upgrading to left bundle branch pacing in patients with pacing-induced cardiomyopathy and infranodal atrioventricular block[J]. Front Cardiovasc Med, 2021, 8: 674452.
[17] YANG Y H, WANG K X, MA P P, et al. His-purkinje system pacing upgrade improve the heart performances in patients suffering from pacing-induced cardiomyopathy with or without permanent atrial fibrillation[J]. Int J Cardiol, 2021, 335: 47-51.
[18] VIJAYARAMAN P, HERWEG B, DANDAMUDI G, et al. Outcomes of His-bundle pacing upgrade after long-term right ventricular pacing and/or pacing-induced cardiomyopathy: insights into disease progression[J]. Heart Rhythm, 2019, 16(10): 1554-1561.
[19] SHAN P, SU L, ZHOU X, et al. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50[J]. Heart Rhythm, 2018, 15(3): 405-412.
[20] QIAN Z, WANG Y, HOU X, et al. Efficacy of upgrading to left bundle branch pacing in patients with heart failure after right ventricular pacing[J]. Pacing Clin Electrophysiol, 2021, 44(3): 472-480.
[21] LI H, WANG L, PENG X, et al. The quality of life of patients with pacemaker-induced cardiomyopathy after they upgrade to left bundle branch pacing[J]. Am J Transl Res, 2021, 13(4): 3044-3053.
[22] WANG N, MA P P, JING Z M, et al. Predictors of pacing-induced cardiomyopathy detection and outcomes demonstration after conduction system pacing upgrade on patients with long-term persistent atrial fibrillation[J]. Pacing Clin Electrophysiol, 2023, 46(7): 684-692.
[23] RADEMAKERS L M, BOUWMEESTER S, MAST T P, et al. Feasibility, safety and outcomes of upgrading to left bundle branch pacing in patients with right ventricular pacing induced cardiomyopathy[J]. Pacing Clin Electrophysiol, 2022, 45(6): 726-732.
[24] DEBRAY T P A, MOONS K G M, RILEY R D. Detecting small-study effects and funnel plot asymmetry in meta-analysis of survival data: a comparison of new and existing tests[J]. Res Synth Methods, 2018, 9(1): 41-50.
[25] SHARMA P S, VIJAYARAMAN P. His bundle pacing or biventricular pacing for cardiac resynchronization therapy in heart failure: discovering new methods for an old problem[J]. J Atr Fibrillation, 2016, 9(4): 1501-1505.
[26] AURICCHIO A, PRINZEN F W. Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues[J]. Circ J, 2011, 75(3): 521-527.
[27] 曹艳杰, 魏璇, 王俊华, 等. 超高龄患者永久心脏起搏治疗的临床观察[J]. 实用临床医药杂志, 2019, 23(10): 36-38,46.
[28] 陈旭华, 华伟. 起搏诱导的心肌病及生理性起搏在其防治中的作用[J]. 中国循环杂志, 2022, 37(8): 855-859.
[29] HUANG W, CHEN X, SU L, et al. A beginner’s guide to permanent left bundle branch pacing[J]. Heart Rhythm, 2019, 16(12): 1791-1796.
[30] SHARMA P S, DANDAMUDI G, HERWEG B, et al. Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: a multicenter experience[J]. Heart Rhythm, 2018, 15(3): 413-420.
[31] CHEN X, YE Y, WANG Z, et al. Cardiac resynchronization therapy via left bundle branch pacing vs. optimized biventricular pacing with adaptive algorithm in heart failure with left bundle branch block: a prospective, multi-centre, observational study[J]. Europace, 2022, 24(5): 807-816.
[32] WU S, SU L, WANG S, et al. Peri-left bundle branch pacing in a patient with right ventricular pacing-induced cardiomyopathy and atrioventricular infra-Hisian block[J]. Europace, 2019, 21(7): 1038.
[33] 宋洪勇, 刘利峰, 殷召, 等. 不同阻滞位置房室传导阻滞患者左束支区域起搏的可行性探讨[J]. 中国循证心血管医学杂志, 2021, 13(5): 608-611,615.
[34] 李晓飞. 左束支区域起搏新技术在心动过缓及心力衰竭患者中的临床应用研究[D]. 北京:北京协和医学院, 2021.