左束支区域起搏治疗慢性收缩性心力衰竭患者的有效性及安全性Meta分析  

Efficacy and Safety of Left Bundle Branch Area Pacing in Patients With Chronic Systolic Heart Failure:a Meta-analysis

作　　者：成雨达 李玉军 齐金磊 刘金玉 王占启[1] CHENG Yuda;LI Yujun;QI Jinlei;LIU Jinyu;WANG Zhanqi(Department of Cardiology,Affiliated Hospital of Hebei University,Baoding(071000),Hebei,China)

机构地区：[1]河北大学附属医院心内科,河北省保定市071000

出　　处：《中国循环杂志》2021年第11期1114-1120,共7页Chinese Circulation Journal

摘　　要：目的:探索左束支区域起搏(LBBAP)治疗慢性收缩性心力衰竭(心衰)患者的有效性及安全性。方法:在PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据库、维普数据库检索关于LBBAP治疗慢性收缩性心衰患者的研究,根据纳入及排除标准筛选文献,提取有效性及安全性数据,进行Meta分析。结果:共纳入9篇文献、537例患者,LBBAP成功率为88.8%。Meta分析结果显示:LBBAP术中及随访时的起搏阈值未见明显差异[均数差(MD)=-0.20,95%CI:-0.46~0.05,P=0.11]。与基线相比,随访时心衰患者的B型利钠肽水平下降(标准MD=-1.35,95%CI:-1.61~-1.09),QRS波时限缩短(MD=-48.52,95%CI:-63.71~-33.32),左心室舒张末期内径(MD=-7.54,95%CI:-11.34~-3.73)及左心室收缩末期内径(MD=-13.62,95%CI:-16.31~-10.93)明显改善,左心室射血分数(MD=16.29,95%CI:12.09~20.49)明显提高,NYHA心功能分级(MD=-1.35,95%CI:-1.61~-1.09)明显降低,差异均有统计学意义(P均<0.05)。平均随访(8.3±6.0)个月,并发症发生率为6.1%,心衰再住院率为3.6%,死亡率为2.3%。结论:LBBAP治疗慢性收缩性心衰患者有效、安全,提示LBBAP可能会成为心脏再同步化治疗的一种替代方案。Objectives:To explore the efficacy and safety of left bundle branch area pacing(LBBAP)in patients with chronic systolic heart failure(HF).Methods:Studies on LBBAP in the treatment of patients with chronic systolic HF were searched in PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang and VIP databases,related studies were screened according to the inclusion and exclusion criteria,data of efficacy and safety were extracted for the meta-analysis.Results:A total of 9 studies with a total of 537 patients were included,the success rate of LBBAP was 88.8%.The results of meta-analysis showed that there was no significant difference in pacing threshold during LBBAP operation and followup(MD=-0.20,95%CI:-0.46 to 0.05,P=0.11).Compared with baseline,brain natriuretic peptide level was significantly decreased(SMD=-1.35,95%CI:-1.61 to-1.09),QRS duration was significantly shortened(MD=-48.52,95%CI:-63.71 to-33.32),left ventricular end diastolic diameter(MD=-7.54,95%CI:-11.34 to-3.73)and left ventricular end systolic diameter(MD=-13.62,95%CI:-16.31 to-10.93)were significantly reduced,left ventricular ejection fraction(MD=16.29,95%CI:12.09 to 20.49)was significantly improved and NYHA grade(MD=-1.35,95%CI:-1.61 to-1.09)was significantly decreased during follow up(all P<0.05).The average follow-up period was(8.3±6.0)months,the incidence of complications was 6.1%,the rehospitalization rate of HF was 3.6%,and the mortality rate was 2.3%.Conclusions:LBBAP is effective and safe for the treatment of patients with chronic systolic HF,results of this analysis show that LBBAP might be an alternative to cardiac resynchronization therapy(CRT).Future head-to head(LBBAP versus CRT)clinical trials are warranted to validate this hypothesis.

关 键 词：左束支区域起搏 收缩性心力衰竭 META分析 心脏再同步化治疗 

分 类 号：R54[医药卫生—心血管疾病]