Long-term and mide-term influences of right ventricular septal pacing and right ventricular apex pacing on left ventricular function:a Meta-analysis

HU Jun; LI Yang; SHI Shui-mei; YU Bo

doi:10.3969/j.1674-4055.2013.04.006

Abstract：Objective To review systematically the mid-term and long-term influences of right ventricular septal pacing and right ventricular apex pacing on left ventricular function. Methods The databases of PubMed, Embase, Cochrane Library, CBM, CNKI, WANGFANG Database and China Scientific Journal Database (CSJD) were retrieved with computers for collecting randomized controlled trials (RCT) about the influences of right ventricular septal pacing and right ventricular apex pacing on left ventricular function. The deadline of the retrieval time was Dec. 2012. All RCT was given quality evaluation, data extraction and Meta-analysis according to the quality evaluation system recommended by Cochrane Collaboration. Results There were totally 20 RCT included involving 1642 patients, and the results of Meta-analysis showed that right ventricular septal pacing was better than right ventricular apex pacing in LVEF after operation for 12 months (MD=4.00, 95%CI:1.87~6.12), LVEF after operation for more than 12 months (MD=5.28, 95%CI:2.53~8.03), NT-proBNP after operation for 12 months (SMD=-0.89, 95%CI:-1.56~-0.22), LVESd after operation for 12 months (MD=-5.24, 95%CI:-9.53~-0.96), Tei index after operation for 12 months (MD=-0.42, 95%CI:-0.18~-0.05), and QRS duration after operation (SMD=-1.16, 95%CI:-1.64~-0.68). There was no significant difference between two methods in LVEDd after operation for 12 months (MD=-0.52, 95%CI:-1.91~0.87) and LVEDV after operation for 12 months (MD=-1.43, 95%CI:-3.72~0.87). Conclusion Right ventricular septal pacing has less influence on left ventricular function compared with right ventricular apex pacing. Because of the limitation of quality and sample quantity, more multiple-center, large-sample and prospective RCT are required for further identifying the results.