Influence Of His-bundle Pacing And Conventional Right Ventricular Pacing On Heart Structure And Function:a Meta-analysis

Objective:To explore the effects of His bundle pacing and traditional right ventricular pacing on cardiac structure and function.Methods:A computerized search of PubMed,Embase,The Cochrane Library,Chinese CNKI,CBM,Wanfang and Weipu Chinese Sci-tech Journals database for effects of His bundle pacing and traditional right ventricular pacing.Relevant data includes:Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),leftventricularend-systolicvolume(LVESV),QRSduration,interventricular asynchrony and New York Heart Association(NYHA)class etc.Using Review Manager 5.3 software for statistical analysis,and the Weighted mean difference(WMD)and 95%confidence interval(CI)were calculated to represent the summary effect.After the comprehensive analysis,if P<0.05,the difference was statistically significant.Results:(1)According to inclusion criteria and exclusion criteria,10 articles were finally included.Including 2 Chinese Literature and 8 English Literature,Publication time:2006~2018 years,A total of 1142 patients with Permanent pacing were enrolled,including 651 males.(2)The results of quantitative analysis are as follows:(1)The 9 articles were included in the analysis finally,Compared with RVP,HBP showed higher LVEF(WMD=5.7%,95%CI:4.5%-6.9%),Heterogeneity is small(I~2=17%),There was a statistical difference between the two groups(P<0.00001).(2)Three articles were included in the analysis,Compared with RVP,HBP showed lower NYHA class(WMD=-0.8,95%CI:-1.0--0.6),No heterogeneity(I~2=0%),There was a statistical difference between the two groups(P<0.00001).(3)Three articles were included in the analysis,Compared with RVP,HBP showed less inter-ventricular asynchrony(SMD=-0.6,95%CI:-1.0--0.3),No heterogeneity(I~2=0%),There was a statistical difference between the two groups(P=0.0005).(4)Four articles were included in the analysis,Compared with RVP,HBP obviously alleviated Mitral regurgitation(SMD=-0.8,95%CI:-1.1--0.4),No heterogeneity(I~2=0%),There was a statistical difference between the two groups(P<0.0001).(5)Nine articles were included in the analysis,Compared with RVP,HBP showed shorter QRS duration(WMD=-39.6 ms,95%CI:-51.9--27.3 ms),Heterogeneity is large(I~2=95%),There was a statistical difference between the two groups(P<0.00001).The reason why there is great heterogeneity may be related to the patient's indications.There is no heterogeneity after the studies containing patients with atrial fibrillation were excluded.It may be that the QRS wave of the patient with atrial fibrillation is variable.When the ventricular rate is too fast,it is easy to cause intraventricular aberrant conduction,resulting in widening of the QRS duration.(6)Four articles were included in the analysis,Compared with RVP,HBP showed higher Pace threshold(WMD=0.81 V,95%CI:0.72-0.9 V),No heterogeneity(I~2=0%),There was a statistical difference between the two groups(P<0.00001).(7)Five articles were included in the analysis,Compared with RVP,HBP had no significant effect on left ventricular end-systolic volume(SMD=-0.1,95%CI:-0.3-0.2),No heterogeneity(I~2=0%),There was not statistical difference between the two groups(P=0.43).Seven articles were included in the analysis,heterogeneity is large(I~2=63%),Defining the source of heterogeneity through excluding literatures one by one,After excluding Jia Xiaoyan's literature,there is no heterogeneity between studies.Compared with RVP,HBP had no significant effect on left ventricular end diastolic volume(SMD=-0.1,95%CI:-0.3-0.1),There was not statistical difference between the two groups(P=0.43).In brief,HBP and RVP had no effect on ventricular volume.Conclusions:Compared with RVP,HBP could improve cardiac function,markedly reduced mitral regurgitation and inter-ventricular asynchrony,and narrow QRS duration.However,it seemed to have no influence on ventricular volume.Moreover,HBP has higher pacing threshold.Although HBP has proven to be a more physiological pacing approach,prospective,large-scale,double-blind,randomized,and multi-center clinical trials are necessary in the future.