Objective To evaluate the effectiveness and safety of AAI pacing mode versus DDD pacing mode for treating sick sinus syndrome (SSS). Methods We electronically searched CENTRAL (Issue 2, 2009), MEDLINE (1980 to June 2009), EMbase (1980 to June 2009) and CBM (1990 to June 2009). Randomized controlled trials (RCTs), quasi- RCTs and cross-over studies were identified and assessed, and then RevMan 5.0 software was used to perform metaanalysis. Results A total of 509 patients of six parallel and two crossover RCTs were identified, and the quality of reporting was found poor. Studies showed a statistically significant preference to AAI pacing mode for the reduction of left atrial diameter (MD=2.09, 95%CI 0.22 to 3.97), left ventricular end-diastolic diameter (MD=3.00, 95%CI –1.58 to 7.58), the prevention atrial fibrillation (P=0.026) and the improvement of life quality (Plt;0.05), but with more replacement or remodulation. Non-significant preference was shown to the prevention of all-cause mortality (P=0.51), cardiovascular mortality (P=0.43), stroke (P=0.32) and heart failure (P=0.17), the reduction of left ventricular end-systolic diameter (MD=1.21, 95%CI –0.85 to 3.28) and left ventricular ejection fraction (MD= –2.91, 95%CI –6.53 to 0.70). No significant adverse effects were reported. Conclusion The review shows a trend towards AAI pacing mode compared with DDD pacing mode in terms of effectiveness. However, because of the high bias risk of the included trials, the evidence is insufficient, so more large-sample and high-quality RCTs are needed.
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.