Application of the LBBP in patients with bradyarrhythmia:Meta-analysis / 中国医学装备

ABSTRACT

Objective:To compare the effects of left bundle branch pacing(LBBP)and right ventricular pacing(RVP)on pacing threshold value,pacing perception,pacing impedance,QRS wave complex duration,interventricular mechanical delay(IVMD)time,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF).Methods:The Chinese databases included China Biology Medicine Disc(CBMdisc),China National Knowledge Infrastructure(CNKI),Wanfang Database,China Science and Technology Journal Database,and foreign databases included PubMed,Cochrane library and Embase were adopted to retrieve research literatures about LBBP.The retrieval duration was from January 2018 to November 2021.The literatures were screened according to the inclusion and exclusion criteria of literatures,and the qualities of the literatures that met the inclusion criteria were respectively evaluated.The extracted relevant data of LBBP and RVP,which included pacing threshold value,pacing perception,pacing impedance,QRS wave complex duration,IVMD time,LVEDD and LVEF,were adopted to conduct Meta-analysis by using Revman5.4.Results:A total of 14 relevant literatures were included according to the inclusion and exclusion criteria of research literatures,which included 9 Chinese literatures and 5 English literatures.The duration of publication times of these literature was from 2018 to 2021.In these literatures,640 patients involved to LBBP and 551 patients involved to RVP.There were no significant differences between LBBP and RVP in the effects on pacing threshold value,pacing perception and pacing impedance[95%CI(-0.05-0.02),(-0.28-0.42),(-22.34-16.19),P>0.05],respectively.There were significant differences between LBBP and RVP in the effects on QRS wave complex duration,IVMD and LVEF[95%CI(-45.92--42.09),(-16.49--10.86),(3.01-5.13),P<0.05],respectively.There were two different results in the effects of LBBP and RVP on LVEDD.The five literatures among of them conducted effect size merging for the extracted LVEDD values.There was significant difference between two kinds of pacing methods in the effect on LVEDD[95%CI(-2.21--0.54),P<0.05].There was significant difference between two kinds of pacing methods in the effect on LVEDD after the literature(ShigengZhang2020)was excluded.Conclusion:The Meta-analysis about the application of LBBP in patients with bradyarrhythmia has demonstrated the effectiveness of LBBP.Compared with RVP,LBBP is more close to physiological pacing,and LBBP pacing parameters(threshold value,perception and impedance)are stable.