Efficacy of His-bundle pacing and right ventricular pacing: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Xing , HE Yi , ZHAN Qilu , ZHOU Jiao ,  DAI Shuren

Cardiovascular Medicine Department of Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, P.R.China;

Corresponding author：

DAI Shuren, Email: 163dsr@163.com

Keywords：

His-bundle pacing; Right ventricular pacing; LVEF; QRS duration; Meta-analysis; Systematic review; Randomized controlled trial; Cohort study

DOI：

10.7507/1672-2531.201903051

Video：

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Objectives To systematically review the efficacy of His-bundle pacing (HBP) and right ventricular pacing (RVP).Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on efficacy of HBP and RVP from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed using RevMan 5.3 software.Results A total of 8 studies involving 1 130 patients were included. The results of meta-analysis showed that: HBP group was superior to RVP group in QRS duration (MD=–43.88, 95%CI –52.53 to –35.22, P<0.000 01), LVEF (MD=4.53, 95%CI 2.67 to 6.38, P<0.000 01), and NYHA (MD=–0.85, 95%CI –1.14 to –0.56, P<0.000 01). However, the operation time (MD=15.21, 95%CI 11.44 to 18.98, P<0.000 01) and fluoroscopy duration (MD=2.98, 95%CI 2.10 to 3.85, P<0.000 01) of HBP group were longer than that of RVP group.Conclusions Current evidence shows that, compared with RVP, HBP is superior in maintaining of QRS duration, LVEF and NYHA; however, the operation time is longer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

Citation： WANG Xing, HE Yi, ZHAN Qilu, ZHOU Jiao, DAI Shuren. Efficacy of His-bundle pacing and right ventricular pacing: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(11): 1286-1291. doi: 10.7507/1672-2531.201903051 Copy

1.	Cicchitti V, Radico F, Bianco F, et al. Heart failure due to right ventricular apical pacing: the importance of flow patterns. Europace, 2016, 18(11): 1679-1688.
2.	Curtis AB, Worley SJ, Chung ES, et al. Improvement in clinical outcomes with biventricular versus right ventricular pacing: the BLOCK HF study. J Am Coll Cardiol, 2016, 67(18): 2148-2157.
3.	Pastore G, Zanon F, Baracca E, et al. The risk of atrial fibrillation during right ventricular pacing. Europace, 2016, 18(3): 353-358.
4.	Kiehl EL, Makki T, Kumar R, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm, 2016, 13(12): 2272-2278.
5.	Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation, 2003, 107(23): 2932-2937.
6.	Hillock RJ, Mond HG. Pacing the right ventricular outflow tract septum: time to embrace the future. Europace, 2012, 14(1): 28-35.
7.	Zhang XH, Chen H, Siu CW, et al. New-onset heart failure after permanent right ventricular apical pacing in patients with acquired high-grade atrioventricular block and normal left ventricular function. J Cardiovasc Electrophysiol, 2008, 19(2): 136-141.
8.	Abdelrahman M, Subzposh FA, Beer D, et al. Clinical outcomes of His bundle pacing compared to right ventricular pacing. J Am Coll Cardiol, 2018, 71(20): 2319-2330.
9.	Deshmukh P, Casavant DA, Romanyshyn M, et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation, 2000, 101(8): 869-877.
10.	Vijayaraman P, Chung MK, Dandamudi G, et al. His bundle pacing. J Am Coll Cardiol, 2018, 72(8): 927-947.
11.	Huang W, Lan S, Wu S, et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. J Am Coll Cardiol, 2018, 72(16): 1835-1856.
12.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
13.	李晓枫, 李超, 冯天捷, 等. 希氏束起搏的安全性及有效性评估. 中国医学前沿杂志(电子版), 2018, 10(5): 51-54.
14.	贾晓艳, 李赐恩, 景莉娟, 等. 希氏束起搏和传统右室心尖起搏对患者心脏结构及功能的影响. 中国循证心血管医学杂志, 2018, 10(1): 78-81.
15.	Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His-bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm, 2018, 15(5): 696-702.
16.	Sharma PS, Dandamudi G, Naperkowski A, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm, 2015, 12(2): 305-312.
17.	Kronborg MB, Mortensen PT, Poulsen SH, et al. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace, 2014, 16(8): 1189-1196.
18.	Catanzariti D, Maines M, Manica A, et al. Permanent His-bundle pacing maintains long-term ventricular synchrony and left ventricular performance, unlike conventional right ventricular apical pacing. Europace, 2013, 15(4): 546-553.
19.	Occhetta E, Bortnik M, Magnani A, et al. Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol, 2006, 47(10): 1938-1945.
20.	Dandamudi G, Vijayaraman P. History of His bundle pacing. J Electrocardiol, 2017, 50(1): 156-160.
21.	Huang W, Su L, Wu S, et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. Heart, 2019, 105(2): 137-143.
22.	Dandamudi G, Vijayaraman P. How to perform permanent His bundle pacing in routine clinical practice. Heart Rhythm, 2016, 13(6): 1362-1366.
23.	Slotwiner DJ, Raitt MH, Del-Carpio Munoz F, et al. Impact of physiologic pacing versus right ventricular pacing among patients with left ventricular ejection fraction greater than 35%. J Am Coll Cardiol, 2019, 74(7): 988-1008.
24.	Ali N, Keene D, Arnold A, et al. His bundle pacing: a new frontier in the treatment of heart failure. Arrhythm Electrophysiol Rev, 2018, 7(2): 103-110.
25.	Patel B, Garg J, Chaudhary R, et al. His bundle pacing: hemodynamics and clinical outcomes. Cardiol Rev, 2018, 26(4): 201-206.
26.	Vijayaraman P, Bordachar P, Ellenbogen KA. The continued search for physiological pacing: where are we now? J Am Coll Cardiol, 2017, 69(25): 3099-3114.

1. Cicchitti V, Radico F, Bianco F, et al. Heart failure due to right ventricular apical pacing: the importance of flow patterns. Europace, 2016, 18(11): 1679-1688.
2. Curtis AB, Worley SJ, Chung ES, et al. Improvement in clinical outcomes with biventricular versus right ventricular pacing: the BLOCK HF study. J Am Coll Cardiol, 2016, 67(18): 2148-2157.
3. Pastore G, Zanon F, Baracca E, et al. The risk of atrial fibrillation during right ventricular pacing. Europace, 2016, 18(3): 353-358.
4. Kiehl EL, Makki T, Kumar R, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm, 2016, 13(12): 2272-2278.
5. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation, 2003, 107(23): 2932-2937.
6. Hillock RJ, Mond HG. Pacing the right ventricular outflow tract septum: time to embrace the future. Europace, 2012, 14(1): 28-35.
7. Zhang XH, Chen H, Siu CW, et al. New-onset heart failure after permanent right ventricular apical pacing in patients with acquired high-grade atrioventricular block and normal left ventricular function. J Cardiovasc Electrophysiol, 2008, 19(2): 136-141.
8. Abdelrahman M, Subzposh FA, Beer D, et al. Clinical outcomes of His bundle pacing compared to right ventricular pacing. J Am Coll Cardiol, 2018, 71(20): 2319-2330.
9. Deshmukh P, Casavant DA, Romanyshyn M, et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation, 2000, 101(8): 869-877.
10. Vijayaraman P, Chung MK, Dandamudi G, et al. His bundle pacing. J Am Coll Cardiol, 2018, 72(8): 927-947.
11. Huang W, Lan S, Wu S, et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. J Am Coll Cardiol, 2018, 72(16): 1835-1856.
12. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
13. 李晓枫, 李超, 冯天捷, 等. 希氏束起搏的安全性及有效性评估. 中国医学前沿杂志(电子版), 2018, 10(5): 51-54.
14. 贾晓艳, 李赐恩, 景莉娟, 等. 希氏束起搏和传统右室心尖起搏对患者心脏结构及功能的影响. 中国循证心血管医学杂志, 2018, 10(1): 78-81.
15. Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His-bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm, 2018, 15(5): 696-702.
16. Sharma PS, Dandamudi G, Naperkowski A, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm, 2015, 12(2): 305-312.
17. Kronborg MB, Mortensen PT, Poulsen SH, et al. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace, 2014, 16(8): 1189-1196.
18. Catanzariti D, Maines M, Manica A, et al. Permanent His-bundle pacing maintains long-term ventricular synchrony and left ventricular performance, unlike conventional right ventricular apical pacing. Europace, 2013, 15(4): 546-553.
19. Occhetta E, Bortnik M, Magnani A, et al. Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol, 2006, 47(10): 1938-1945.
20. Dandamudi G, Vijayaraman P. History of His bundle pacing. J Electrocardiol, 2017, 50(1): 156-160.
21. Huang W, Su L, Wu S, et al. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. Heart, 2019, 105(2): 137-143.
22. Dandamudi G, Vijayaraman P. How to perform permanent His bundle pacing in routine clinical practice. Heart Rhythm, 2016, 13(6): 1362-1366.
23. Slotwiner DJ, Raitt MH, Del-Carpio Munoz F, et al. Impact of physiologic pacing versus right ventricular pacing among patients with left ventricular ejection fraction greater than 35%. J Am Coll Cardiol, 2019, 74(7): 988-1008.
24. Ali N, Keene D, Arnold A, et al. His bundle pacing: a new frontier in the treatment of heart failure. Arrhythm Electrophysiol Rev, 2018, 7(2): 103-110.
25. Patel B, Garg J, Chaudhary R, et al. His bundle pacing: hemodynamics and clinical outcomes. Cardiol Rev, 2018, 26(4): 201-206.
26. Vijayaraman P, Bordachar P, Ellenbogen KA. The continued search for physiological pacing: where are we now? J Am Coll Cardiol, 2017, 69(25): 3099-3114.

Chinese Journal of Evidence-Based Medicine

Efficacy of His-bundle pacing and right ventricular pacing: a meta-analysis

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