| Objective: To compare the electrophysiological changes after left bundle branch regional pacing and right ventricular pacing,evaluate the impact of the two pacing positions on the heart and imaging changes,and explore the safety and stability of left bundle branch regional pacing.Methods: All literatures related to left bundle branch regional pacing from the establishment of databases to February 25,2020 were searched.For the retrieved literature,a separate database was established,the duplicate literature was removed from the database,the literature was screened according to the standards specified in this study,and then the quality was evaluated according to different literature categories,and finally the data needed for this study was extracted.For the final selected data,Revman 5.3 statistical software was used to process,which was expressed in the form of forest map.Results: 13 articles were finally included,including 8 in Chinese and5 in English.Publication time: 2018~2020 period.A total of 657 patients with permanent pacemakers were included.(1)Left ventricular ejection fraction.2 articles were included,and the LBBP group and the RVP group had no significant difference in left ventricular ejection fraction(P=0.09).WMD =-2.05,95% CI:-04.44-0.35,the heterogeneity is small(I~2=36%).(2)The end-diastolic diameter of the left ventricle.2 articles were included,and the LBBP group and the RVP group had no significant difference in the left ventricular end-diastolic diameter(P=0.37 > 0.05).WMD =-2.05,95% CI:-1.07-2.85,the heterogeneity is small(I~2=11%).(3)Synchronization in the left ventricle.Included in 2 articles,the LBBP group was significantly better than the RVP group in the left ventricular synchronization(P < 0.01).WMD =-21.06,95% CI:-26.52--15.60,with small heterogeneity(I~2=44%).(4)QRSd.In 4 articles,the QRSd in the LBBP group was significantly shorter than that in the RVP group(P < 0.01).WMD =-25.1,95% CI:-27.7—-22.6,low heterogeneity,(I~2=34%).(5)The pacing threshold.Included in 6 articles,and the LBBP group and the RVP group had no significant difference in pacing threshold(P=0.09>0.05).WMD =-0.04,95% CI:-0.08-0.01,the heterogeneity is small(I~2=41%).(6)Pacing impedance.Included in 8 articles,and the LBBP group and the RVP group had no significant difference in impedance(P=0.73>0.05). WMD = 2.4,95% CI:-11.1-15.9,no heterogeneity(I~2=0%).(7)Sensing amplitude.Included in 8 articles,the LBBP group and the RVP group had no significant difference in the perceived amplitude(P=0.67> 0.05).WMD = 0.43,95% CI:-1.57-2.4,with high heterogeneity(I~2=84%).(8)Operation time.Included in 3 articles,the operation time of the LBBP group was significantly longer than that of the RVP group(P<0.01).WMD = 35.32,95% CI: 20.15-50.50,high heterogeneity(I~2=86%).(9)X-ray exposure time.Included in 3 articles,the operation X-ray exposure time of LBBP group was significantly longer than that of RVP group(P=0.01 < 0.05).WMD = 2.76,95% CI: 0.66—4.85,with high heterogeneity(I~2=95%).conclusion:This meta-analysis shows that left bundle branch pacing is no less effective and stable than right ventricular pacing.Compared with right ventricular pacing,left bundle branch pacing does not have the disadvantage of QRSd and has higher ventricular synchrony.After a short period of follow-up,there was little difference between the two groups in pacing threshold,impedance,perceived amplitude and left ventricular end diastolic diameter.The operation time and X-ray exposure time of left bundle branch pacing group were significantly longer than those of right ventricular pacing group.However,the follow-up time of the above studies was short,and the endpoint events and prognosis could not be observed.More multicenter,long-term,prospective clinical trials with more patients need to be included for further exploration. |
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