Effects of Right Ventricular Non-Apical Pacing and Right Ventricular Apical Pacing on Left Ventricular Function: A Systematic Review and Meta-Analysis

Early studies suggested that right ventricular apical pacing could have non-beneficial effects on left ventricular function. While right ventricular non-apical pacing may have significantly beneficial effects and could be a good alternative to right ventricular apical pacing is unknown. A systematic review and meta-analysis were conducted to compare the mid and long-term effects of right ventricular non-apical pacing and right ventricular apical pacing on left ventricular function. We conducted randomized controlled trials and retrospective cohort studies on patients with pacemakers to compare right ventricular apical and right ventricular non-apical. We evaluated patient’s left ventricular ejection fraction, 6 min walk test, blood N-terminal pro-brain peptide, or brain natriuretic peptide. The results are expressed as the mean difference of the 95 % confidence interval. A total of 1181 references were included for evaluating the relevance. From this, 10 studies with 1246 patients have fulfilled the inclusion criteria (mean age ranged from 55 y to 85 y; male 62 %; 622 (50 %) right ventricular apical; 624 (50 %) right ventricular non-apical). There was no difference between the right ventricular apical and right ventricular non-apical groups in baseline left ventricular ejection fraction groups (mean difference=0.32, 95 % confidence interval (-0.70, 1.34), p=0.98, random effect model) and postoperative 6 min walking test (mean difference=5.14, 95 % confidence interval (-6.60, 16.89), p=0.51, I2=0 %). In terms of left ventricular ejection fraction index and N-terminal pro-brain natriuretic peptide or brain natriuretic peptides, the right ventricular non-apical group was better than the right ventricular apical group (mean difference=-0.74, 95 % confidence interval (-2.24, 0.77), p<0.0001, I2=56 %). Sensitivity analysis and funnel chart showed that our research is robust and has low publication bias. Our results showed that right ventricular non-apical pacing had significant beneficial effects on postoperative left ventricular ejection fraction than right ventricular apical pacing in patients with a pacemaker implanted for more than 1 y.