Endocardial versus epicardial pacing in pacemaker-dependent patients after device extraction: a meta-analysis.

IF 2.9 3区医学 Q3 ENGINEERING, BIOMEDICAL

Expert Review of Medical Devices Pub Date : 2023-07-01 DOI:10.1080/17434440.2023.2223968

Antonio Parlavecchio, Giampaolo Vetta, Rodolfo Caminiti, Michele Magnocavallo, Manuela Ajello, Giuseppe Dattilo, Rosario Foti, Gianluca Di Bella, Sameer Saeed Ahmed Al-Maisary, Giovanni Coluccia, Pietro Palmisano, Domenico Giovanni Della Rocca, Pasquale Crea

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引用次数: 1

Abstract

Introduction: Pacemaker-dependent (PM) patients with cardiac implantable electronic device (CIED) infection require implantation of a temporary-pacemaker (TP) and delayed endocardial reimplantation or implantation of an epicardial-pacing-system (EPI) before device extraction. Our aim was to compare the TP and EPI-strategy after CIED extraction through a meta-analysis.

Methods: We searched electronic databases up to 25 March 2022, for observational studies that reported clinical outcomes of PM-dependent patients implanted with TP or EPI-strategy after device extraction.

Results: 3 studies were included enrolling 339 patients (TP: 156 patients; EPI: 183 patients). TP compared to EPI showed reduction in the composite outcome of relevant complications (all-cause death, infections, need for revision or upgrading of the reimplanted CIED) (12.1% vs 28.9%; RR: 0.45; 95%CI: 0.25-0.81; p = 0.008) and a trend in reduction of all-cause death (8.9% vs 14.2%; RR: 0.58; 95%CI: 0.33-1.05; p = 0.07). Furthermore, TP-strategy proved to reduce need of upgrading (0% vs 12%; RR: 0.07; 95%CI: 0.01-0.52; p = 0.009), reintervention on reimplanted CIED (1.9% vs 14.7%; RR: 0.15; 95%CI: 0.05-0.48; p = 0.001) and significant increase in pacing threshold (0% vs 5.4%; RR: 0.17; 95%CI: 0.03-0.92; p = 0.04), with a longer discharge time (MD: 9.60 days; 95%CI: 1.98-17.22; p = 0.01).

Conclusion: TP-strategy led to a reduction of the composite outcome of all-cause death and complications, upgrading, reintervention on reimplanted CIED, and risk of increase in pacing threshold compared to EPI-strategy, with longer discharge time.

查看原文本刊更多论文

心脏起搏器依赖患者心脏内膜起搏与心外膜起搏:一项荟萃分析。

导读:心脏植入式电子装置(CIED)感染的起搏器依赖(PM)患者需要植入临时起搏器(TP)和延迟心内膜再植或植入心外膜起搏系统(EPI)，然后再取出装置。我们的目的是通过荟萃分析比较在CIED提取后TP和epi策略。方法:我们检索了截至2022年3月25日的电子数据库，以获取报告pm依赖患者在器械取出后植入TP或epi策略的临床结果的观察性研究。结果:纳入3项研究，共纳入339例患者(TP: 156例;EPI: 183例)。与EPI相比，TP显示相关并发症(全因死亡、感染、重新植入CIED的翻修或升级需求)的综合结果降低(12.1% vs 28.9%;RR: 0.45;95%置信区间:0.25—-0.81;P = 0.008)和全因死亡减少的趋势(8.9% vs 14.2%;RR: 0.58;95%置信区间:0.33—-1.05;p = 0.07)。此外，tp策略被证明减少了升级需求(0% vs 12%;RR: 0.07;95%置信区间:0.01—-0.52;p = 0.009)，再植CIED再干预(1.9% vs 14.7%;RR: 0.15;95%置信区间:0.05—-0.48;P = 0.001)和起搏阈值显著升高(0% vs 5.4%;RR: 0.17;95%置信区间:0.03—-0.92;p = 0.04)，且出院时间较长(MD: 9.60 d;95%置信区间:1.98—-17.22;p = 0.01)。结论:与epi策略相比，tp策略降低了全因死亡和并发症的综合结局，改善了再植CIED的功能，降低了再干预的风险，增加了起搏阈值的风险，且出院时间更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Medical Devices 医学-工程：生物医学

CiteScore

5.90

自引率

3.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal serves the device research community by providing a comprehensive body of high-quality information from leading experts, all subject to rigorous peer review. The Expert Review format is specially structured to optimize the value of the information to reader. Comprehensive coverage by each author in a key area of research or clinical practice is augmented by the following sections: Expert commentary - a personal view on the most effective or promising strategies Five-year view - a clear perspective of future prospects within a realistic timescale Key issues - an executive summary cutting to the author''s most critical points In addition to the Review program, each issue also features Medical Device Profiles - objective assessments of specific devices in development or clinical use to help inform clinical practice. There are also Perspectives - overviews highlighting areas of current debate and controversy, together with reports from the conference scene and invited Editorials.