希氏束起搏用于心脏再同步治疗系统的文献回顾和荟萃分析  

His bundle pacing for cardiac resynchronization therapy:a systematic literature review and meta-analysis

作　　者：齐金磊 成雨达 孟小敏[1] 李向欣[2] 贾辛未[1] 王占启[1] Qi Jinlei;Cheng Yuda;Meng Xiaomin;Li Xiangxin;Jia Xinwei;Wang Zhanqi(Department of Cardiology,Affiliated Hospital of Hebei University,Baoding 071000,China;Coronary Care Unit,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院心内科,保定071000 [2]河北大学附属医院心脏重症监护室,保定071000

出　　处：《中华心律失常学杂志》2021年第4期337-341,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的系统回顾已发表的关于希氏束起搏(HBP)用于心脏再同步治疗(CRT)的文献,并评价该治疗的可行性和有效性。方法检索PubMed、Cochrane Library、Embase、中国知网和万方数据库,从数据库建立至2019年12月,以确定相关研究。感兴趣的临床结局指标包括植入成功率、QRS时限、起搏阈值、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、心功能,并发症和病死率。对数据进行提取和汇总,应用Revman5.3软件进行荟萃(meta)分析。结果共纳入13项研究,涉及503例患者。永久性HBP可导致QRS时限明显缩短,从(165.5±8.7)ms降至(122.9±12.0)ms(MD=43.5,95%CI 36.34~50.56,P<0.001)。与基线起搏阈值相比,随访时起搏阈值有上升趋势(MD=-0.24,95%CI-0.38~-0.10,P=0.001)。心功能(NYHA分级,MD=1.2,95%CI 1.09~1.31,P<0.001)、LVEF(MD=-12.60,95%CI-14.32~-10.87,P<0.001)、LVEDD(MD=4.30,95%CI 3.05~5.55,P<0.001),在>3个月随访时较基线明显改善。10项研究报道了安全信息,最常见的并发症是起搏阈值的增加。结论HBP用于CRT是可行的,具有较高的成功率。HBP可显著缩短QRS时限,改善随访期间左心室功能。Objective To systematically review published studies of His bundle pacing(HBP)for cardiac resynchronization therapy(CRT)and evaluate the feasibility and efficacy of the therapy.Methods PubMed,Cochrane Library,Embase,CNKI and WANFANG databases were searched up to December 2019 to identify relevant studies.Clinical outcomes of interest include implant success rate,QRS duration,pacing thresholds,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),NYHA status,complications,and mortality.The data were extract and summarized.Revman 5.3 software was used for meta-analysis.Results A total of 13 studies involving 503 patients were included in this meta-analysis.Permanent HBP significantly shortened mean QRS duration,from(165.5±8.7)ms to(122.9±12.0)ms(MD=43.5,95%CI 36.34-50.56,P<0.001).Compared with the baseline pacing threshold,the pacing threshold had an upward trend at follow-up(MD=-0.24,95%CI-0.38--0.10,P=0.001).Average NYHA functional class(MD=1.2,95%CI 1.09-1.31,P<0.001),LVEF(MD=-12.60,95%CI-14.32--10.87,P<0.001),LVEDD(MD=4.30,95%CI 3.05-5.55,P<0.001)significantly improved at>3 months follow-up compared to the baseline.Ten studies reported safety information,and the most common complication was the increase in His bundle capture threshold.Conclusion HBP is feasible with high success rates in patients requiring CRT.HBP could significantly shorten QRS duration and improve left ventricular function during follow-up.

关 键 词：心脏再同步治疗 希氏束起搏 荟萃分析 系统回顾 

分 类 号：R541.6[医药卫生—心血管疾病]