Comparison of electrocardiogram characteristics between left bundle branch pacing and right ventricular septal pacing in patients receiving pacemaker therapy

Background and Objective Cardiac pacing is an effective therapy in patients with bradycardia.Conventional right ventricular(RV)pacing is the source of ventricular dyssynchrony,leading to unfavorable clinical outcome.This study compared the electrocardiogram(ECG)characteristics during left bundle branch pacing(LBBP)with that during RV septal pacing(RVSP)which has been thought to be better than RV apical pacing.

Right ventricular septal pacing: Safety and efficacy in a long term follow up

AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.

The importance of avoiding unnecessary right ventricular pacing in clinical practice

Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with longterm pacing of the apex of the right ventricle(RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function(LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing(cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.

Right Ventricular Outflow Tract Septal Pacing versus Apical Pacing: A Prospective, Randomized, Single-blind 5-Years Follow-up Study of Ventricular Lead Performance and Safety

Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.

Minimizing right ventricular pacing in sinus node disease: Sometimes the cure is worse than the disease

Traditional right ventricular(RV) apical pacing has been associated with heart failure, atrial fibrillation and increased mortality. To avoid the negative consequences of RV apical pacing different strategies have been developed, among these a series of pacing algorithms designed to minimize RV pacing. These functions are particularly useful when there is not the need for continuous RV pacing: intermittent atrioventricular blocks and, mainly, sinus node disease. However, in order to avoid RV pacing, the operationalfeatures of these algorithms may lead to adverse(often under-appreciated) consequences in some patients. We describe a case of a patient with sinus node disease, in whom right atrial only pacing involved long atrio-ventricular delay to allow intrinsic ventricular conduction, which led to symptomatic hypotension that could be overcome only by "forcing" also right ventricular apical pacing. We subsequently discuss this case in the context of current available literature.

Implantation of Lumenless Pacing Leads at the Inter-atrial Septum and Right Ventricular Outflow Tract with Deflectable Catheter-sheath

Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class Ⅰ indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French （Fr） lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath （Medtronic Inc., USA） were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results （mean atrial pacing threshold： 0.87 V; mean P wave amplitude： 2.28 mV; mean ventricular pacing threshold： 0.53V; mean R wave amplitude： 8.75 mV） were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible.

Hemodynamic improvement by right ventricular septal pacing in elderly patients with chronic atrial fibrillation and slow ventricular response

Background and objectives Right ventricular apical(RVA)pacing has been reported impairing left ventricular(LV)performance.Alternative pacing sites in right ventricle(RV)has been explored to obtain better cardiac function.Our study was designed to compare the hemodynamic effects of right ventricular septal(RVS)pacing with RVA pacing.Methods Ten elderly patients with chronic atrial fibrillation(AF)and long RR interval or slow ventricular response(VR)received VVI pacing.The hemodynamic difference between RVS and RVA pacing were examined by transthoracic echocardiography(TTE).Results Pacing leads were implanted successfully at the RVA and then RVS in all patients without complication.The left ventricular(LV)parameters,measured during RVA pacing including left ventricular ejection fraction(LVEF),FS,stroke volume(SV)and peak E wave velocity(EV)were decreased significantly compared to baseline data,while during RVS pacing,they were significantly better than those during RVA pacing.However,after 3-6 weeks there was no statistical significant difference between pre-and post-RVS pacing.Conclusions The LV hemodynamic parameters during RVA pacing were significantly worse than baseline data.The short term LV hemodynamic parameters of RVS pacing were significantly better than those of RVA pacing;RVS pacing could improve the hemodynamic effect through maintaining normal ventricular activation sequence and biventricular contraction synchrony in patients with chronic AF and slow ventricular response.

Long-term follow-up of right ventricular outflow tract septal pacing

Objective Right ventricular outflow tract septum has become widely used us an electrode placement site. However, data concerning lead performances and complications for lead repositioning with this technique were scant. The purpose of this study was to observe long- term lead performances and complications of right ventricular outflow tract septal pacing and provide evidences for choosing an optimal electrode implantation site. Methods Thirty-six patients with septal active electrode implantation and 39 with apical passive electrode implantation were enrolled in this study. Pacing threshold, R-wave sensing, lead impedance, pacing QRS width and pacing-related compli- cations for two groups at implantation and follow-up were compared. Results There were higher pacing threshold and shorter pacing QRS width at implantation in the septal group compared with the apical group. There were no differences between the septal and the apical groups in pacing threshold, R-wave sensitivity, lead impedance and pace-related complication during a follow-up. Conclusions Right ventricular outflow tract septum could be used as a first choice for implantation site because it had long-term stable lead performances and no serious complications compared with the traditional apical site.

Comparison of His-purkinje bundle pacing and right ventricular inflow tract septal pacing in the elderly

Objective To compare the short-term clinical effect and electrical parameters of His-purkinje bundle pacing(HPBP) and right ventricular inflow tract septal pacing(RVIP) in the elderly. Methods Between April 2017 and September 2019, sixty patients with indications for permanent cardiac pacing and resynchronization therapy in Beijing Anzhen Hospital were divided into the HPBP and RVIP groups, and were analyzed. A ventricular pacing lead was implanted in left ventricular septal sites with left bundle potentials or His potentials in the HPBP group. The lead was placed in right ventricular inflow tract septal sites close to distal His-bundle regions without potentials from the His-purkinje conduction system in the RVIP group. Lead impedance, R wave amplitude, pacing thresholds, QRS duration, left ventricular ejection fraction(LVEF), and left ventricular end-diastolic diameter(LVEDD), mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio were compared between the HPBP and RVIP groups during the procedure and the short-month follow-up. Results No significant differences were found in lead impedance, R wave amplitude, QRS duration, LVEF, LVEDD, mitral regurgitation area reflux, QTc, T wave directivity, Tp-e and Tp-e/QT ratio between the HPBP and RVIP groups. However, the pacing threshold was significantly lower in the HPBP group than in the RVIP group(0.7 ± 0.2 vs. 0.9 ± 0.3 V, P = 0.02). Conclusions The efficacy and electrical parameters of HPBP is comparable with RVIP during the procedure and the short-term follow-up.

Right ventricular pacing: the best site is yet to be defined

The right ventricular (RV) apex is the traditional site to provide stable and reliable chronic ventricular pacing. Interest in alternate site pacing has grown since RV apical pacing has been associated with increased mortality and morbidity compared to normal atrio-ventricular conduction. 1-4 Alternate pacing sites include the RV septum and outflow tract.

Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis:A systematic review

BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.

The Prevalence and Short-Term Outcomes of Ventricular Dyssynchrony after Right Ventricular Pacing

Objective: Long-term right ventricular pacing has been associated with an increased risk of heart failure and cardiomyopathy. The pathophysiology of cardiomyopathy associated with right ventricular pacing remains unclear. We aim to evaluate the burden and short-term outcomes of ventricular dyssynchrony after immediate permanent pacemaker implantation. Materials and Methods: This prospective cohort study examined consecutive patients who had permanent pacemaker implantation at Vajira Hospital in 2019. Left ventricular systolic function, specifically left ventricular ejection fraction (LVEF) and echocardiographic ventricular dyssynchrony parameters were assessed. The endpoints included the prevalence of ventricular dyssynchrony, new-onset cardiomyopathy, heart failure, and death. The correlation between QRS complex duration, the burden of ventricular pacing, and echocardiographic ventricular dyssynchrony was measured. Results: Thirty-six consecutive patients underwent pacemaker implantation. The prevalence of mechanical ventricular dyssynchrony was 22.2% using the interventricular conduction delay method, 41.7% using LV pre-ejection period method, and 11.1% using the septal posterior wall motion abnormality method. Electrical ventricular dyssynchrony was 86.1% and new-onset cardiomyopathy was 17.1% after 3 months of permanent pacemaker implantation. The right ventricular pacing of more than 20% was significantly associated with cardiomyopathy (p < 0.022) and heart failure (log-rank, p = 0.049) within 3 months. But heart failure was not associated with mechanical ventricular dyssynchrony parameters (log-rank, p = 0.610;hazard ratio [HR], 1.53;95% confidence interval [CI], 0.29 - 7.96;p = 0.613 for IVMD and log-rank, p = 0.398;HR, 0.04;95% CI, 0.01 - 3316.7 for SPWMD). Conclusion: Mechanical and electrical ventricular dyssynchrony are common findings in right ventricular pacing. High-burden right ventricular pacing after 3 months of permanent pacemaker implantation is often associated with cardiomyopathy and heart failure, but mechanical and electrical ventricular dyssynchrony does not predict a short-term decline in left ventricular systolic function and heart failure.

Cardiac resynchronization therapy improved the clinical outcomes in pacemaker patients upgraded to biventricular device

The right ventricular pacing （RVP） is the standard treat- ment for patients with severe bradyarrhythmias; however, it may cause and exacerbate heart failure symptoms in a long run under some circumstances.{1] In fact, significant left ventricular （LV） systolic dysfimction and symptomatic heart failure （HF） is commonly found in patient population with pacemaker implantations.

希氏束起搏与右心室心尖部起搏对房室传导阻滞患者心脏结构学参数与功能学参数影响的临床研究

目的:探究希氏束起搏(HBP)与右心室心尖部起搏(RVAP)对房室传导阻滞(AVB)患者心脏结构学参数与功能学参数的影响。方法:选取收治的104例AVB患者为研究对象,随机分为HBP组和RVAP组各52例,HBP组行HBP治疗,RVAP组行RVAP治疗,比较两组术前、术后心脏结构学参数、心脏起搏参数、心率和血流动力学参数[心率(HR)、每搏输出量(SV)、心脏指数(CI)和左室射血分数(LVEF)]及QRS时限变化情况。结果:两组手术前后心脏结构学参数左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)比较,差异均无统计学意义(均P>0.05);术中、术后1个月、术后6个月心脏起搏阈值、R波幅度、电极阻抗比较无统计学差异(均P>0.05);术前、术后1个月,两组HR、SV、CI、LVEF、QRS时限比较无统计学差异(均P>0.05);术后6个月,HBP组HR、SV、CI、LVEF显著高于RVAP组(均P<0.05),RVAP组QRS波时限显著低于HBP组(P<0.05);结论:HBP对AVB患者的电-机械同步性优于RVAP,近期心脏血流动力学及心功能稳定性良好。

激动标测和起搏标测联合指引下解剖消融治疗特发性右室流出道室性早搏的效果

目的探讨激动标测和起搏标测联合指引下解剖消融治疗特发性右室流出道(RVOT)室性早搏的临床价值。方法回顾性分析2023年1—10月在郑州大学第一附属医院心血管内科和许昌市中心医院心血管内科住院接受室性早搏射频消融术的36例患者的资料,经电生理检查证实室性早搏来源于RVOT,根据术中室性早搏数量多少灵活采用激动标测和或起搏标测找到靶点进行对应肺动脉根部瓣下和瓣上联合消融,分析该方法即刻及3个月成功率。结果术中室性早搏数量少的患者也可以快速有效地进行导管消融术并取得满意的远期效果。结论激动标测和起搏标测联合指引下解剖消融治疗特发性RVOT室性早搏临床可行,效果较好。

左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响

目的探讨左束支区域起搏与右心室间隔起搏技术对老年患者左心室收缩同步性、心功能的影响。方法回顾性选取2022年2月至2023年3月期间于郴州市第一人民医院心血管内科接受永久性心脏起搏器植入术治疗的80例老年患者的临床资料,根据心脏起搏电极植入部位分为两组,即对照组、观察组各40例。对照组患者于右心室间隔处植入心脏起搏器,观察组患者于左束支区域植入心脏起搏器。分别于患者心脏起搏器植入术后1个月、术后6个月、术后12个月观察各指标变化,包括左心室收缩同步性参数[左心室收缩期纵向应变达峰时间标准差(time to peak longitudinal strain standard deviation,Tls-SD)、最大差值(time to peak longitudinal strain maximum difference,Tls-dif),左心室收缩期径向应变达峰时间标准差(time to peak radial strain standard deviation,Trs-SD)、最大差值(time to peak radial strain maximum difference,Trs-dif),左心室收缩期环向应变达峰时间标准差(time to peak circumferential strain standard deviation,Tcs-SD)、最大差值(time to peak circumferential strain maximum difference,Tcs-dif)]以及心功能指标[左心室射血分数(left ventricular ejection fraction,LVEF)、心排血量(cardiac output,CO)、心脏指数(cardiac index,CI)]、心腔大小[右心房内径(right atrial inner diameter,RAD)、左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)]、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度等。于术后12个月测定起搏参数(感知、阈值、阻抗、心室起搏比例),并统计心脏起搏器植入术后12个月内心力衰竭再入院、死亡等不良事件发生情况。结果术后各时间点观察组心功能指标LVEF、CO、CI略高于对照组,但两组比较差异无统计学意义(P>0.05)。术后各时间点观察组心腔大小指标RAD、LAD、LVEDD、LVESD低于对照组,尤其是术后12个月[RAD:(36.63±2.22)mm vs.(40.13±1.61)mm,LAD:(31.09±1.14)mm vs.(38.32±1.08)mm,LVEDD:(49.76±3.22)mm vs.(54.63±3.14)mm,LVESD:(40.64±2.11)mm vs.(48.11±3.24)mm,P<0.05]。术后各时间点观察组左心室收缩同步性指标LSDI、Tls-SD、Tls-dif、Trs-SD、Trs-dif、Tcs-SD、Tcs-dif均低于对照组,尤其是术后12个月[LSDI:4.86%±0.83%vs.9.49%±0.48%,Tls-SD:(14.42±1.78)ms vs.(25.00±1.43)ms,Tls-dif:(50.92±4.53)ms vs.(90.17±8.41)ms,Trs-SD:(50.37±4.33)ms vs.(69.44±6.52)ms,Trs-dif:(141.03±15.64)ms vs.(179.04±18.42)ms,Tcs-SD:(37.85±3.41)ms vs.(48.10±4.62)ms,Tcs-dif:(130.09±14.53)ms vs.(158.09±18.57)ms,P<0.05]。术后各时间点观察组NT-proBNP浓度略低于对照组,但两组比较差异无统计学意义(P>0.05)。两组起搏程控参数起搏感知、阻抗比较,差异无统计学意义(P<0.05);观察组起搏阈值低于对照组[(0.66±0.10)V vs.(0.75±0.12)V,P<0.05];两组起搏程控参数起搏感知、阻抗、阈值均处于正常范围。观察组心室起搏比例低于对照组(43.23%±4.53%vs.73.43%±6.56%,P<0.05)。术后12个月观察组心力衰竭再入院发生率明显低于对照组,差异有统计学意义(5.00%vs.22.50%,P<0.05)。结论左束支区域起搏技术在改善永久性心脏起搏器植入患者左心室收缩同步性、心功能方面优于右心室间隔起搏技术,术后12个月不良事件发生率较低,更有利于保护心功能,起搏参数稳定,属于一种有效且安全的起搏技术。

主动固定电极对心脏起搏器置入术患者心室起搏参数的影响

目的探讨与分析主动固定电极对心脏起搏器置入术患者心室起搏参数的影响。方法选择2020年1月—2023年4月新疆生产建设兵团第二师库尔勒医院收治的需安置埋藏式心脏起搏器的85例患者作为研究对象,根据随机掷骰子原则把85例患者分为主动组(43例)与被动组(42例)。主动组采用主动固定电极行右室流出道间隔部、希氏束起搏治疗,被动组采用被动固定电极行右室心尖部起搏治疗,记录与观察两组心室起搏参数变化情况。结果主动组起搏器置入即刻的心室起搏参数起搏阈值、阻抗、P波幅度、电流均明显低于被动组,差异有统计学意义(P<0.05)。主动组电极置入时间、曝光时间均长于被动组,差异有统计学意义(P<0.05)。主动组电极置入后7 d起搏系统感染、下肢深静脉血栓、起搏电极脱位、起搏功能障碍等并发症发生率明显低于被动组,差异有统计学意义(P<0.05)。主动组的下肢制动时间、住院时间、临时心脏起搏电极留置时间均短于被动组,差异有统计学意义(P<0.05)。结论主动固定电极在心脏起搏器置入术患者中的应用能改善其心室起搏参数,增加患者的电极置入时间、曝光时间,减少右心尖起搏带来的心室非同步的电激动,降低患者的并发症发生率,改善患者的总体预后。

左束支区域起搏对房室传导阻滞患者术后新发房性心律失常的影响

目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。

希浦系统起搏对心功能影响的研究进展

心脏起搏是心脏起搏、传导功能障碍及严重心力衰竭的有效治疗手段,但传统右心室起搏可增加心力衰竭、心房颤动发生率,双心室起搏具有相对较高的无应答率。近年来多项研究显示,希浦系统起搏作为生理性起搏新技术,起搏参数稳定,心脏同步性好。本文就目前希浦系统起搏对心功能影响的研究现状及进展进行综述,为促进希浦系统起搏技术发展提供理论依据。

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

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。