左心室喷射率大于35%的患者中生理节奏与右心室节奏的影响:2018年ACC/AHA/HRS关于评估和治疗心和心脏导电延迟患者的指南的系统审查:美国心脏病学会/美国心脏协会临床实践指南工作组的报告和心律学会
Circulation
|December 28, 2018
概括
与右心室节奏相比,使用双心室节奏 (BiVP) 或他的捆节奏 (HisBP) 的生理节奏保持或改善左心室喷射分数 (LVEF). 患有慢性心房的患者接受AV结节切除时,临床益处最为明显.
科学领域:
- 心脏病学
- 电生理学
- 医疗器械
背景情况:
- 右心室节奏 (RVP) 可能导致不良的心脏结构和功能变化.
- 包括双心节律 (BiVP) 和His捆节律 (HisBP) 在内的生理节律的减轻这些影响的潜力尚未完全理解.
研究的目的:
- 审查现有文献,并确定与RVP相比,BiVP和/或HisBP是否可以防止不良重塑.
- 在没有严重左心室功能障碍的患者中评估BiVP/ HisBP与RVP的结构,功能和临床优势.
主要方法:
- 进行了随机试验和观察性研究的元分析.
- 在MEDLINE (PubMed) 和Embase搜索了比较BiVP或HisBP与RVP的研究.
- 包括的研究测量了左心室尺寸,射出分数 (LVEF),心力衰竭分类,生活质量和死亡率.
主要成果:
- 分析了8项涉及679名患者的研究.
- 生理步调 (BiVP/ HisBP) 显著降低了 LV 容量,并保持/ 改善了 LVEF (平均随访时间为 1.57 - 1. 64 年).
- 在LVEF> 35%的患者和经过AV结节切除的慢性心房动患者中,益处更为明显.
结论:
- 与RVP相比,BiVP和HisBP在LVEF> 35%的患者中保持或改善LVEF.
- 主要在特定的患者群体中观察到以患者为中心的临床结果改善,特别是那些患有慢性心房的患者.
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