心脏再同步治疗中自动算法的临床结果:系统审查和元分析
Leonardo Knijnik1, Bo Wang1, Rhanderson Cardoso2
1Emory University Adult Congenital Heart Center, Atlanta, Georgia.
Heart rhythm O2
|November 8, 2023
概括
用于心脏再同步治疗 (CRT) 的自动算法不能改善死亡率或心力衰竭住院治疗. 这些先进的CRT算法在心力衰竭患者中没有显著的临床益处.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 临床试验 临床试验
背景情况:
- 在心脏再同步疗法 (CRT) 设备中,用于心房 (AV) 和心室间 (VV) 间隔的自动调整算法被广泛使用.
- 然而,这些自动CRT算法的临床有效性仍然不确定.
研究的目的:
- 评估自动CRT算法的对死亡率,心力衰竭住院和心力衰竭患者临床改善的影响.
- 在CRT设备中评估动态AV和VV间隔调整的有效性.
主要方法:
- 使用自动AV和VV间隔调整算法,对涉及CRT患者的随机对照试验 (RCT) 进行系统审查和元分析.
- 对基于心内电图 (EGM) 和基于收缩性的算法进行了子组分析.
主要成果:
- 分析了9个带有8531名参与者的RCT,50.1%接受了自动算法.
- 自动和对照组之间没有观察到任何原因死亡率 (10.3%对11.3%) 或心力衰竭住院 (15.0%对16.1%) 的显著差异.
- 临床改善率相似 (66.6%对63.3%),在以收缩性为基础的子组中,有利于自动算法的非显著趋势 (75%对68.3%).
结论:
- 在CRT设备中调整AV或VV间隔的自动算法没有显示出死亡率,心力衰竭住院或心血管症状的显著改善.
- 目前的证据表明,在CRT心力衰竭患者中,这些自动调整特征没有增加的临床益处.
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