The effect of pacing at different sites on cardiac function ： A network analysis

Abstract

Abstract Background: The slow arrhythmia caused by sick sinus syndrome and conduction disorder is mainly manifested in palpitation, dizziness, and even syncope. If not treated in time, it will lead to heart failure, shock, and even endanger the life of patients, posing a great threat to the life and health of patients.At present, the most effective treatment is pacemaker implantation.Pacemaker can help excite the patient's heart according to the patient's own heart rate, thus treating bradyarrhythmia.The ventricular pacing electrode can be placed at multiple locations. Pacing at different locations in the medium and long term may have different effects on the heart function of patients[1]。 Objective: To investigate the effects of right ventricular middle septum (RVMS), right ventricular high septum (RVHS), right ventricular septum (RVS), right ventricular outflow tract (RVOT), right ventricle (RVA) and His bundle (HB) pacemakers on left ventricular function 6 to 36 months after implantation. Methods PubMed, Embase, Cochrane and Wanfang databases were searched through computer retrieval databases. The retrieval time was up to June 2022. Clinical studies on the effects of pacing at different sites on left ventricular function were collected, and the effects of pacing at different sites on left ejection fraction (LVEF), 6-minute walk test (6MWT), NT proBNP, and QRS duration were compared. Results: A total of 14 randomized controlled trials were included in our research;All trials were reported postoperative LVEF, 7 trials were reported 6MWT, 5 trials were reported NT proBNP, and 8 trials were reported QRS duration;The results of reticular meta-analysis showed that in terms of LVEF, HB group was superior to other groups in SMD-0.82 (95% CI-1.28, -0.37) in RVS group and SMD-0.77 (95% CI-1.34, -0.19) in RVB group. There was no statistical difference between RVHS group, RVMS group, RVOT group and each group.In 7 articles about the study of 6MWT after pacemaker implantation, the HB group was superior to the RVA group SMD-0.51 (95% CI-0.99, -0.03), and there was no statistical significance between other groups.The SUCRA scores were HB (92.9)>RVS (72.5)>RVHS (30.7)>RVMS (24.6).Five articles related to the study of NT proBNP after pacemaker implantation, HB group was better than RVA group SMD 0.42 (95% CI 0.06,0.79);SMD 0.67 (95% CI 0.13,1.21) in RVS group;SMD 0.69 (95% CI 0.24,1.13) in RVHS group was not significantly different from that in RVMS group.There was no statistical significance between the RVMS group and each group. The HB group was the best, and the SUCRA score was 97.8 for HB.In 8 articles about the study of QRS duration after pacemaker implantation, the HB group was superior to the RVA group SMD1.79 (95% CI 0.32,3.27).There was no statistical significance among other groups.HB group was the best, and the SUCRA score was 85.8. Conclusion: His bundle pacing is the best in hemodynamics and ventricular synchrony.