Reduction in unnecessary ventricular pacing fails to affect hard clinical outcomes in patients with preserved left ventricular function: a meta-analysis

【Abstract】 Background:Cardiac pacemakers are still an effective method for the treatment of atrioventricular block diseases(AVB). Ventricular pacing results in adverse clinical outcome. For patients with atrioventricular conduction system disease, minimization ventricular pacing not be used to reduce the proportion of ventricular pacing and improve cardiac function. Recent studies have shown that His bundle pacing(HBP) can be an effective treatment for patients with atrioventricular block . The purpose of this study was to evaluate the effectiveness of His bundle in patients with AVB. Methods:We searched the studies from Pubmed,Embase and Cochrane Library database to evaluate the application of HBP in patients with AVB. From these studies, we extrated and summarized the related data such as implantation success rate, QRS width, pacing threshold at baseline and follow-up, assessment left ventricular function, complications. Results:This Meta- analysis included eight studies, including 430 patients. The success rate of implantation varied from 65% to 93%. The main indications of HBP were patients with AVB, including patients with atrioventricular node block and intranodal block. Left ventricular function(left ventricular ejection fraction) was not significantly improved during follow-up. The duration of QRS after HBP implantation was more narrow (113±18ms). Compared with the baseline level, the threshold of HBP was not significantly increased during follow-up. During an average of 12 months of follow-up, pacemaker-related complications occurred in 16 patients. Conclusion:Permanent HBP has shown promising results for patients with AVB in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.

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Effect of Exercise-Based Cardiac Rehabilitation on Left Ventricular Function in Asian Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Healthcare ◽

10.3390/healthcare9060774 ◽

2021 ◽

Vol 9 (6) ◽

pp. 774

Author(s):

Yanjiao Wang ◽

Ching-Wen Chien ◽

Ying Xu ◽

Tao-Hsin Tung

Keyword(s):

Myocardial Infarction ◽

Left Ventricular Function ◽

Ventricular Function ◽

Meta Analysis ◽

Coronary Intervention ◽

Left Ventricular ◽

Mean Difference ◽

Controlled Trials ◽

Randomized Controlled ◽

Percutaneous Coronary

(1) Background: The effects of exercise-based cardiac rehabilitation (CR) on left ventricular function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) are important but poorly understood. (2) Purpose: To evaluate the effects of an exercise-based CR program (exercise training alone or combined with psychosocial or educational interventions) compared with usual care on left ventricular function in patients with AMI receiving PCI. (3) Data sources, study selection and data extraction: We searched PubMed, WEB OF SCIENCE, EMBASE, EBSCO, PsycINFO, LILACS and Cochrane Central Register of Controlled Trials databases (CENTRAL) up to 12th June 2021. Article selected were randomized controlled trials and published as a full-text article. Meta-analysis was conducted with the use of the software Review manager 5.4. (4) Data synthesis: Eight trials were included in the meta-analysis, of which three trials were rated as high risk of bias. A significant improvement was seen in the exercise-based CR group compared with the control group regarding left ventricular ejection fraction (LVEF) (std. mean difference = 1.33; 95% CI:0.43 to 2.23; p = 0.004), left ventricular end-diastolic dimension (LVEDD) (std. mean difference = −3.05; 95% CI: −6.00 to −0.09; p = 0.04) and left ventricular end-systolic volume (LVESV) (std. mean difference = −0.40; 95% CI: −0.80 to −0.01; p = 0.04). Although exercise-based CR had no statistical effect in decreasing left ventricular end-systolic dimension (LVESD) and left ventricular end-diastolic volume (LVEDV), it showed a favorable trend in relation to both. (5) Conclusions: Exercise-based CR has beneficial effects on LV function and remodeling in AMI patients treated by PCI.

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