希氏束起搏在心力衰竭患者中应用疗效的meta分析

Efficacy of His bundle pacing in patients with heart failure:a meta-analysis

目的通过meta分析方法综合评估希氏束起搏在心力衰竭患者中应用的疗效。方法检索数据库(Cochrane Library、PubMed、Embase、万方数据库、维普数据库、中国知网数据库、中国生物医学数据库)中评估希氏束起搏在心力衰竭患者中应用疗效相关文献,收集符合纳入标准的研究中患者基线资料及随访前后QRS波时限、左室射血分数、起搏阈值等指标并进行meta分析。采用Stata 12.0软件分析。结果共纳入14篇研究,包括539例心力衰竭患者,平均年龄70.9岁。meta分析结果显示,希氏束起搏显著缩短QRS波时限(WMD=-51.51ms,95%CI=-59.50^-43.52,P<0.01),改善心力衰竭患者左室射血分数(WMD=10.91%,95%CI=7.55~14.27,P<0.01)。然而与基线相比,希氏束起搏阈值存在上升趋势(WMD=0.26V,95%CI=0.15~0.36,P<0.01)。结论希氏束起搏可显著改善心力衰竭患者心功能。未来需要更多大样本临床随机对照研究来证实希氏束起搏在心力衰竭患者中的应用疗效。

Objective To investigate the efficacy of His bundle pacing in patients with heart failure via a meta-analysis.MethodsDatabases(Cochrane Library,PubMed,Embase,Wanfang Database,VIP Database,CNKI Database,Sinomed)were searched to select the studies that meet the inclusion criteria and evaluate the efficacy of His bundle pacing in patients with heart failure.Data were collected and analyzed of QRS duration,left ventricular ejection fraction,pacing threshold at baseline and follow-up.Analysis was performed using Stata 12.0.Results A total of 14 studies were included,enrolling 539 patients with heart failure(mean age:70.9 years).Meta-analysis showed that His bundle pacing significantly shortened the QRS duration(WMD=-51.51ms,95%CI=-59.50 to-43.52,P<0.01)and improved left ventricular ejection fraction(WMD=10.91%,95%CI=7.55 to 14.27,P<0.01).However,compared with baseline,His bundle capture threshold tended to be higher(WMD=0.26V,95%CI=0.15 to 0.36,P<0.01).Conclusion His bundle pacing can significantly improve cardiac function in patients with heart failure.More large-scale clinical randomized controlled trials are needed in the future to confirm the efficacy of His bundle pacing in such patients.