The Effects Of Pacing From Different Ventricular Sites On Heart Function: A Meta-analysis

Objective: To systematically evaluate the effects of pacing from different right ventricular sites on heart function.Methods: Electronic search was conducted to identify clinical trials for comparing the effects of pacing from the right ventricular apex(RVA) and right ventricular outflow tract(RVOT) on heart function, for inclusion, trials had to divide into different groups according to pacing sites,measure method,years of follow-up. And then, the same parameter was analysis by computer program of Review Manager 4.2.Results: At last, 23 articles were collected, the results of Meta analysis showed that: on acute hemodynamic effects pacing from right ventricular outflow tract cardiac output(CO) and cardiac index(CI) are higher than pacing from right ventricular apex, and pulmonary capillary wedge pressure(PCWP) is lower than pacing from right ventricular apex, but no differences in mean pulmonary arterial pressure(mPAP),left ventricular end-diastolic pressure(LVEDP),+dp/dt,-dp/dt. long-term effects on heart function, VVI pacing from right ventricular apex decrease left ventricular ejection fraction and increase left atrial diameter(LADd), but DDD pacing from right ventricular apex, because the parameter existing significant heterogeneity, no confirm outcomes.Conclusions: On acute hemodynamic effects, pacing from right ventricular outflow tract is superior to pacing from right ventricular apex. long-term effects on heart function, VVI pacing from right ventricular apex decrease left ventricular function, but DDD pacing from right ventricular apex,powered large trials are needed to confirm the outcomes.