This meta-analysis was designed to determine the effect of an intracardiac lateral tunnel (ILT) versus an extracardiac conduit (ECC) on patients undergoing a Fontan procedure. A search of the literature in PubMed, Embase, China Academic Literature, and Wanfang databases yielded 23 studies comprising approximately 1000 patients for analysis. There were statistically significant differences between ILT and ECC in the frequency of early sinus node dysfunction, early total arrhythmias, late supraventricular tachycardia, late sinus node dysfunction, late total arrhythmias, and need for pacemaker. By contrast, no statistically significant differences between the two methods were found in takedown, protein-losing enteropathy, thromboembolic events, early supraventricular tachycardia, early mortality, and total mortality. We conclude that an ECC confers some advantages over an ILT, although the underlying mechanism remains unclear.
OBJECTIVE: The quality of paediatric clinical practice guidelines (CPGs) for the management of Mycobacterium tuberculosis infection is unclear. We aimed to comprehensively assess the quality of these CPGs and identify areas requiring improvement.DESIGN: CPGs were systematically searched and identified before being appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Reporting Items for Practice Guidelines in HealThcare (RIGHT) tools. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC).RESULTS: Twenty-five CPGs were evaluated. All CPG agreements among four reviewers were good (ICC 0.753–0.939). The mean CPG score was 50.5% (23.5–78.4%), and seven CPGs were recommended for use. The mean scores of three domains were low: 38% for stakeholder involvement (5.6–93.1%), 38.4% for rigour of development (1–97.4%) and 36.3% for applicability (12.5–64.6%). The mean reporting rate of Reporting Items for Practice Guidelines in HealThcare fields was 41.8%, and the evidence field had the highest reporting rate (63.1%), while the review and quality assurance field had the lowest rate (15.4%) for CPGs that include methods.CONCLUSION: The methodological and reporting quality of the CPGs was variable and poor, respectively. More effort is needed in stakeholder involvement, rigour of development, applicability domains and reporting to produce higher-quality CPGs.
Objective To study the safety and electrical characteristics of various implanting sites of the Micra pacemaker. Method A total of 15 patients from Beijing Anzhen Hospital, Capital Medical University, were included, who were implanted with Micra leadless pacemakers and allocated to either the high ventricular septum group (eight patients) or the low ventricular septum group (seven patients) based on their individual patient factors and clinical conditions. The baseline of the patients, the implanting area, the electrocardiogram change after implantation, the implantation data, the threshold, R wave, impedance, and the date of the 1‐month follow‐up were then analyzed. With all of the data, the characteristics of different implantation sites of the Micra pacemaker were determined. Results Overall, the thresholds were low at implantation and remained stable over the 1‐, 3‐, 6‐month, 1‐, 2‐, 3‐, and 4‐year follow‐ups. On comparing the two groups, there was no difference in QRS duration at pacing (140.00 [40.00] ms vs. 179.00 [50.00] ms), threshold at implantation (0.38 [0.22] mV vs. 0.63 [1.00] mV), R wave at implantation ([10.85 ± 4.71] V vs. [7.26 ± 2.98] V), or impedance at implantation ([906.25 ± 162.39] Ω vs. [750.00 ± 173.40] Ω). While the difference in QRS duration between the two groups was not significant, the QRS duration of the high ventricular septum group exhibited a reduced tendency compared with that of the low ventricular group. The corrected QT interval during pacing exhibited a significant difference (440.00 [80.00] ms vs. 520.00 [100.00] ms; p < .05). For the 1‐, 3‐, 6‐month, 1‐, 2‐, 3‐, and 4‐year follow‐ups, there was no difference between the threshold of the high ventricular septum group and that of the low ventricular septum group (p > .05). Conclusion High ventricular septum pacing appears to be a safe site for implantation of the Micra pacemaker. It could entail a shorter QRS duration at pacing and could be more physiological than low ventricular septum pacing.
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