无导线心脏起搏器和传统心脏起搏器术后并发症的荟萃分析

Meta-analysis of complications associated with implantation of leadless pacemaker and conventional pacemaker

目的比较无导线心脏起搏器和传统心脏起搏器术后并发症。方法计算机检索PubMed、Embase、Google Scholar、The Cochrane Library、Clinical Trials、中国知网、万方数据库,搜索无导线起搏器和传统起搏器植入的对照研究,检索时限均从建库至2020年2月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3进行荟萃分析。结果最终纳入5个研究,共2913例患者,其中无导线心脏起搏器组(无导线组)1091例,传统心脏起搏器组(传统组)1822例。荟萃分析显示,与传统组比较,无导线组感染性心内膜炎发生率较低(OR=0.07,95%CI:0.01~0.52,P<0.05),而血管并发症发生率较高(OR=4.55,95%CI:1.90~10.89,P<0.01)。两组在三尖瓣损伤/功能障碍、起搏电极脱位、心包积液/穿孔、感染等方面的差异无统计学意义(P≥0.05)。结论与传统起搏器植入术相比,无导线心脏起搏器术后感染性心内膜炎少而血管并发症多。

Objective To evaluate complications associated with implantation of leadless and conventional cardiac pacemaker.Methods The electronic databases including PubMed,Embase,Google Scholar,The Cochrane Library,Clinical Trials,CNKI and WangFang were searched systematically from first date of publication until February 2020 to collect comparative studies of complications associated with implantation of leadless pacemarker and conventional pacemarker.Two reviewers independently screened literatures,extracted data and assessed risk of bias of these studies.A meta-analysis was performed using RevMan 5.3 software.Results A total of 5 studies involving 2913 patients were finally enrolled,including 1091 patients implanted with leadless cardiac pacemaker(LCP group)and 1822 patients with conventional cardiac pacemaker(CCP group).Meta-analysis showed that compared with CCP group,LCP group had less endocarditis(OR=0.07,95%CI:0.01~0.52,P<0.05),but more vascular complications(OR=4.55,95%CI:1.90~10.89,P<0.01).There was no significant difference in tricuspid valve damage and dysfunction,lead dislodgment,pericardial effusion and perforation,and infection between the two groups(P≥0.05).Conclusion There is less endocarditis but more vascular complications after implantation of leadless cardiac pacemaker than conventional cardiac pacemaker.