title: Effects of right ventricular nonapical pacing on cardiac function: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the effects of right ventricular nonapical (RVNA) and right ventricular apical (RVA) pacing on cardiac function.
  
  
  METHODS
  A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Library to identify RCTs comparing RVNA pacing with RVA pacing with follow-up ≥2 months. Twenty RCTs involving 1,114 patients were included.
  
  
  RESULTS
  Compared with RVA pacing, RVNA (mainly right ventricular septum [RVS]) pacing exhibited not only excellent pacing threshold and R-wave amplitude but also higher impedance. RVNA pacing showed a significant increase in left ventricular ejection fraction (LVEF) at the end of follow-up (weighted mean difference = 3.58, 95% confidence interval = 1.80-5.35), and the effects were observed in the following subgroups: 6-month follow-up, ≤12-month follow-up, >12-month follow-up, baseline LVEF ≤45%, and baseline LVEF >45%. RVS and RVA pacing significantly differed in improving LVEF (weighted mean difference = 4.82, 95% confidence interval = 2.78-6.87). In addition, RVNA pacing resulted in a narrower QRS duration, a smaller left ventricular end-systolic volume, and a lower New York Heart Association functional class.
  
  
  CONCLUSIONS
  This meta-analysis found that RVNA (mainly RVS) pacing exhibited satisfactory long-term lead performance compared with RVA pacing and demonstrated beneficial effects in improving LVEF after the 6-month follow-up. Furthermore, it proved superior to RVA pacing in terms of interventricular synchrony and cardiac function.
authors: Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan City, China.
authors: Wang
authors: W
authors: Weizong
authors: Wang
authors: W
authors: Zhongsu
authors: Zhang
authors: Z
authors: Yujiao
authors: Gao
authors: G
authors: Mei
authors: Wang
authors: W
authors: Jiangrong
authors: Zhang
authors: Z
authors: Yong
authors: Xie
authors: X
authors: Xinxing
authors: Hou
authors: H
authors: Yinglong
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000401:mortality*; D015897:Comorbidity; D006325:Heart Atria; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000401:mortality* / Q000517:prevention & control*
keywords: cardiac function; electrical parameters; meta-analysis; randomized controlled trials; right ventricular nonapical pacing