Right Ventricular Outflow Tract Pacing for Heart Function: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

1. Evidence-Based Medicine Center of Lanzhou University, Basic Science School of Lanzhou University, Lanzhou 730000, China; 2. The First Medical College of Lanzhou University, Lanzhou 730000, China; 3.The Second Medical College of Lanzhou University, Lanzhou 730000,China;

Corresponding author：

Keywords：

Right ventricular outflow tract; Right ventricular apex; Pacing; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20100431

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Objective 　To systematically evaluate the clinical effectiveness of right ventricular outflow tract (RVOT) pacing for heart disease.
Methods 　We searched the electronic bibliographic databases, including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI, and WANFANG database to assemble the randomized controlled trials (RCTs) of RVS Pacing compared with right ventricular apical (RVA) pacing for heart disease. The deadline of the retrieval time was January 2010. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for meta-analysis.
Results 　A total of 16 RCTs involving 926 patients were included. The results of meta-analyses showed that right ventricular outflow tract (RVOT) pacing significantly increased the left ventricular ejection fraction of 3 months and 18 months (WMD= 3.53, 95%CI 1.02 to 6.04; WMD= 8.94, 95%CI 7.35 to 10.52).Compared with RVA pacing, RVOT pacing could significantly reduce the QRS wave duration (WMD= –22.42, 95%CI –31.05 to – 13.80) immediately after the operation.
Conclusion 　RVOT pacing can give patients a good physiological state which is more consistent with biventricular electric conduction and lead to the hemodynamic improvement in the short term, but the long-term result is not confident.

Citation： ZHANG Yulong,PAN Hui,MA Bin,GUO Jiwu,LI Jiang,YANG Kehu. Right Ventricular Outflow Tract Pacing for Heart Function: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2010, 10(4): 476-482. doi: 10.7507/1672-2531.20100431 Copy

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2.	Kutarski A, Rucinski P, Sodolski T, et al. Factors influencing differences of RVA & RVOT pacing hemodynamic effects. Europace, 2005, 7(3): 165-166.
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10.	巩雪, 宿燕岗, 潘文志. 右室流出道与右室心尖部起搏对心脏收缩功能和左室重构的影响. 中国心脏起搏与心电生理杂志, 2009, 23(3): 212-214.
11.	辛丽红. 右心室不同起搏部位的血流动力学研究. 实用心脑肺血管病杂志, 2008, 16(4): 17-19.
12.	史玉露, 丁坤, 孙春启. 右心室流出道间隔部螺旋电极起搏对血流动力学的影响. 淮海医药, 2009, 27(3): 193-195.
13.	陈若菡. 生理性起搏——起搏部位和起搏方式的临床研究. 北京: 中国协和医科大学, 2006.
14.	崔俊友, 张华, 殷泉忠, 等. 主动电极在右室流出道间隔部起搏的临床应用. 南京医科大学学报(自然科学版), 2009, 29(8): 1124-1127.
15.	郭应军, 李雪山, 王国军, 等. 主动固定电极在右室流出道间隔部起搏的临床研究. 热带医学杂志, 2008, 8(7): 702-703.
16.	郝静, 毛家亮, 张琪, 等. 右室流出道室间隔和右室心尖部起搏心电图的对照研究. 上海医学, 2007(S1): 90-91.
17.	王蔚, 起搏器植入术后心脏结构和心功能变化研究. 上海: 复旦大学, 2008.
18.	毛家亮, 郝静, 张琪, 等. 右室流出道室间隔主动电极和右室心尖部被动电极的对照研究. 中国心脏起搏与心电生理杂志, 2007, 21(3): 203-205.
19.	石泉, 右室流出道起搏的临床研究. 山西: 南昌大学, 2009.

1. Thambo JB, Bordanchar P, Garrigue SEA. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation, 2004, 110(25): 3766-3772.
2. Kutarski A, Rucinski P, Sodolski T, et al. Factors influencing differences of RVA & RVOT pacing hemodynamic effects. Europace, 2005, 7(3): 165-166.
3. McGavigan AD, Mond HG. Selective site ventricular pacing. Curr Opin Cardiol, 2006, 21(1): 7- 14.
4. Tse HF, Yu C, Wong KK, et al. Functional abnormalities in patients with permanent right ventricular pacing: the effect of sites of electrical stimulation. J Am Coll Cardiol, 2002, 40(8): 1451-1458.
5. 陈泗林, 林纯莹, 费洪文, 等. 不同部位起搏对心室同步性的影响. 中国现代医学杂志, 2009, 19(15): 2336-2338.
6. 李萍, 石泉, 胡建新, 等. 永久右心室流出道起搏临床评价. 临床荟萃, 2009, 24(8): 683-685.
7. 刘庆军, 钱剑峰, 刘峰, 等. 右室流出道间隔部起搏的血流动力学观测. 心脏杂志, 2008, 26(06): 773-775.
8. 王宏伟, 刘培敏, 许长存, 等. 右室流出道间隔部与心尖部起搏对心功能的影响. 临床心电学杂志, 2008, 17(3): 195-196.
9. 郑舒. 右室流出道起搏和心尖部起搏对心脏运动同步性和心功能影响的比较. 山东: 青岛大学. 2009.
10. 巩雪, 宿燕岗, 潘文志. 右室流出道与右室心尖部起搏对心脏收缩功能和左室重构的影响. 中国心脏起搏与心电生理杂志, 2009, 23(3): 212-214.
11. 辛丽红. 右心室不同起搏部位的血流动力学研究. 实用心脑肺血管病杂志, 2008, 16(4): 17-19.
12. 史玉露, 丁坤, 孙春启. 右心室流出道间隔部螺旋电极起搏对血流动力学的影响. 淮海医药, 2009, 27(3): 193-195.
13. 陈若菡. 生理性起搏——起搏部位和起搏方式的临床研究. 北京: 中国协和医科大学, 2006.
14. 崔俊友, 张华, 殷泉忠, 等. 主动电极在右室流出道间隔部起搏的临床应用. 南京医科大学学报(自然科学版), 2009, 29(8): 1124-1127.
15. 郭应军, 李雪山, 王国军, 等. 主动固定电极在右室流出道间隔部起搏的临床研究. 热带医学杂志, 2008, 8(7): 702-703.
16. 郝静, 毛家亮, 张琪, 等. 右室流出道室间隔和右室心尖部起搏心电图的对照研究. 上海医学, 2007(S1): 90-91.
17. 王蔚, 起搏器植入术后心脏结构和心功能变化研究. 上海: 复旦大学, 2008.
18. 毛家亮, 郝静, 张琪, 等. 右室流出道室间隔主动电极和右室心尖部被动电极的对照研究. 中国心脏起搏与心电生理杂志, 2007, 21(3): 203-205.
19. 石泉, 右室流出道起搏的临床研究. 山西: 南昌大学, 2009.

Chinese Journal of Evidence-Based Medicine

Right Ventricular Outflow Tract Pacing for Heart Function: A Meta-analysis

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