房室结消融术联合心脏再同步化治疗对心力衰竭合并心房颤动患者疗效的网状荟萃分析

打开文本图片集

Network Meta-Analysis of Efficacy of Atrioventricular Node Ablation Combined with Cardiac Resynchronization Therapy in Patients with Heart Failure and Atrial Fibrillation

DING Huaisheng 1，2 ，CHEN Jing 1，3 ，LI Peng1，2

（1.West China Hospital Sichuan University，Meishan Hospital，Meishan 620o1，Sichuan，China；2.Departmentof Cardiovascular Medicine，Meishan People's Hospital，Meishan 620o10，Sichuan，China；3. Department of Scienceand Education，Meishan People's Hospital，Meishan 62Oo10，Sichuan，China）

【Abstract】ObjectiveForhartfailurepatientswithapidventricularresponseinducedbyatrialfibriltion，atrioventricularode ablationcombidwitdiacsychozatiotapyisanmpoantmeasuetomproeprogosisissudyistvauatelcal benefitsof iferentcardiacresychronzatiotherapyrategiestroughasystematicevieandmetaanalysis.MetodsLiteraturesarchs wereconductedinPubMed，TeCochraneLibrary，Embase，CNKI，andWanfangdatabasesfromtheirinceptiontoJune2O25.Sesiiity analyseswereperfmedbasedonstudytypes（randomizedcontroledtrialsandcohortstudies）toasestherobustnessoftheresults. ElectrophsioicaldpotserefiedsQduatondhocardiogapcdntsasangesinftventclartofractio （LVEF）.Secondaryendpointsincludedpacingthresholdandal-causemortality.StatisticalanalyseswereperformedusingStata14.0. ResultsAtotalof7studiesinvolving594patientswereincluded.Meta-analysisresultsshowedtatcomparedwithbiventricularpacing （BVP），Hisbundle pacing（HBP）and eftbundle branch area pacing（LBBAP）had greateradvantages inshortening QRSdurationHBPvs BVP：mean difference （MD）=-53 .81ms，95%CI-68.00～-39.62；LBBAPvsBVP ：MD=-44 .12ms，95%CI-58.30～-29.95]. Echocardiographic analysis indicated that HBP significantly improved LVEF compared with BVP（ MD=8 .76 % ，95% CI 2.14～15.39）. Compared with BVP，LBBAP reduced all-cause mortality（ OR=0 10，95%CI 0. 01～0. 78 ），while there was no significant difference in mortality between LBBAP and HBP.Additionally，the pacing threshold of LBBAP was significantly lower than that of HBP （MD=-0，41 1 I，95%CI-.55～-0.27）.ConclusionLBBAPoutpeforstraditionalBVPinimprovingLVEFandreducingalcausemortaliydits pacingthresholdislowerthanHBP，suggestingthatLBBAPmayhavepotentialclinicaladvantagesoverHBPforpatientsundergoing atrioventricularnodeablationand pacemakerimplantation.

【Keywords】His bundle pacing;Left bundle brancharea pacing;Atrioventricular node ablation;Cardiacresynchronizationtherapy

心房颤动（atrialfibrillation，AF）是临床常见的心律失常，其引发的快速心室率常诱发或加剧心力衰竭（heartfailure，HF）急性失代偿进程。（剩余12345字）