| Objectives:1、To study the relationship between the left ventricular pacing electrode position of cardiac resynchronization therapy(CRT)and patients with chronic heart failure efficacy.2、To analyze the optimal location of left ventricular pacing electrode position of cardiac resynchronization therapy(CRT),and to provide theoretical evidence for the improvement of the clinical efficacy of CRT on patients with chronic heart failure.Methods:The document database is effectively and accurately retrieved,Such as:the Chinese biomedical literature database(CBM),the Chinese knowledge network database(CNKI),the Wanfang database and the VP database(VIP),Cochrane Library,PubMed,EMBASE,Web of Science.The retrieval time limit is from the initial database to February 28,2018.Then,according to the literature inclusion and exclusion criteria,the selected articles were selected by item,Extracting useful data from the literature.Cochrane collaborative network bias risk assessment tool is used to evaluate the quality of documents.The quantitative analysis of literature is based on heterogeneity test and I~2 selection of suitable effect models.Comprehensive analysis of extracted data by Meta analysis software Review Manage 5.1.Results:1,According to inclusion criteria and exclusion criteria,12 articles were finally included.Including 6 Chinese Literature and 6 English Literature,Publication time:2003~2017 years,A total of 985 patients with chronic heart failure(CRT)were enrolled,including 752 males.2,The results of quantitative analysis are as follows:2.1,The 12 articles were included in the analysis finally,the left ventricular pacing electrode placement that is lateral wall group in CRT was higher than that in the non lateral wall group,and the left ventricular ejection fraction(LVEF)increased,But the heterogeneity is large(P<0.0001,SMD=2.6,95%CI:1.59~3.60,I~2=71%).Literature analysis of the inclusion,The timing of CRT after heart failure in different literatures is different,one week,3 months,6 months,one year and two years,respectively.2.1.1,CRT post time less than 3 months,4 articles were included in the analysis,The left ventricular pacing electrode placement that is lateral wall group in CRT was higher than that in the non lateral wall group,and the left ventricular ejection fraction(LVEF)increased,There is still greater heterogeneity(P=0.08,SMD=0.56,95%CI:-1.62~2.73,I~2=56%).The random effects analysis model was selected to study(P=0.08,SMD=0.13,95%CI:-0.30~0.56,I~2=55%).There was no statistical difference between the two groups(P=0.54).It may be due to shorter treatment time after CRT,Incomplete recovery of myocardial synchrony,Or there are other factors of influence.2.1.2,CRT post time is equal to 6 months,four articles were included in the analysis,The left ventricular pacing electrode placement that is lateral wall group in CRT was higher than that in the non lateral wall group,and the left ventricular ejection fraction(LVEF)increased,No heterogeneity(P=0.76,SMD=1.42,95%CI:0.04~2.80,I~2=0%),there was a statistical difference between the two groups(P=0.04).2.1.3,CRT post time is more than 1 years,five articles were included in the analysis,The left ventricular pacing electrode placement that is lateral wall group in CRT was higher than that in the non lateral wall group,and the left ventricular ejection fraction(LVEF)increased,No heterogeneity(P=0.76,SMD=6.73,95%CI:4.87~8.60,I~2=0%),There was a statistical difference between the two groups(P<0.01).2.2,Five articles were included in the analysis,the left ventricular pacing electrode placement that is lateral wall group in CRT was lower than that in the non lateral wall group,and the QRS wave time limit(dQRS)decreased.There was no significant heterogeneity(P=0.35,SMD=-11.84,95%CI:-16.37~-7.31,I~2=9%),There was a statistical difference between the two groups(P<0.01).2.3,Five articles were included in the analysis,the left ventricular pacing electrode placement that is lateral wall group in CRT was lower than that in the non lateral wall group,and the left ventricular end diastolic diameter(LVEDD)decreased.Heterogeneity is small(P=0.27,SMD=-3.93,95%CI:-6.41~-1.45,I~2=23%).There was a statistical difference between the two groups(P=0.002).2.4,Four articles were included in the analysis,the left ventricular pacing electrode placement that is lateral wall group in CRT was lower than that in the non lateral wall group,and the Left ventricular end systolic volume(LVESV)decreased.No heterogeneity(P=0.96,SMD=-9.95,95%CI:-24.31~4.41,I~2=0%).But there was no significant difference between the two groups(P=0.17).2.5,three articles were included in the analysis,The left ventricular pacing electrode placement that is lateral wall group in CRT was higher than that in the non lateral wall group,and the 6 minute walk distance(6MWD)increased.No heterogeneity(P=0.68,SMD=11.20,95%CI:-14.30~36.69,I~2=0%),But there was no significant difference between the two groups(P=0.39).Conclusion:The location of left ventricular pacing electrode in CRT is closely related to the clinical outcome and prognosis of patients with chronic heart failure after CRT.The left ventricular pacing electrode placement that is lateral wall group is better than the non lateral wall in the treatment of heart failure.Meta analysis suggests:The clinician gave CRT to patients with heart failure,Left ventricular pacemaker implantation site preferentially select left ventricular lateral wall under physiological and anatomical conditions,the better the effect of CRT in patients with heart failure.However,However,it is necessary to further prove that by more high-quality,large sample,different center,prospective RCT research. |
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