Abstract：
BACKGROUND: The long-term success rate of pulmonary vein isolation (PVI) is suboptimal due to the presence of non-pulmonary vein (PV) foci that can trigger atrial fibrillation (AF) in up to 11%. Among non-PV triggers, the superior vena cava (SVC) is a major site of origin of ectopic beats initiating AF.
OBJECTIVE: To compare data from randomized controlled trials (RCTs) assessing PVI + empiric SVC isolation (SVCI) versus PVI alone in terms of AF recurrence, procedure-related complications, and fluoroscopic and procedural times.
METHODS: A search of online scientific libraries (from inception to April 1, 2024) was performed. Four RCTs were considered eligible for the meta-analysis totaling 600 patients of whom 287 receiving PVI + SVCI and 313 receiving PVI alone.
RESULTS: In the overall population, SVCI + PVI was associated with a non-significant reduction of AF recurrence at follow-up (0.66 [0.43;1.00], p = 0.05, I2 0%). In patients with paroxysmal AF (PAF), a significant reduction of AF recurrence was related to SVCI + PVI (11.7%) as compared to PVI alone (19.9%) (0.54 [0.32;0.92], p = 0.02, I2 0%). No statistical differences were found among the groups in terms of fluoroscopic (3.31 [- 0.8;7.41], p = 0.11, I2 = 91%), procedural times (5.69 [- 9.78;21.16], p = 0.47, I2 = 81%), and complications (1.06 [0.33;3.44], p = 0.92, I2 = 0%).
CONCLUSIONS: The addition of SVCI to PVI in patients in PAF is associated with a significant lower rate of AF recurrence at follow-up, without increasing complication rates and procedural and fluoroscopy times.
OBJECTIVE: To compare data from randomized controlled trials (RCTs) assessing PVI + empiric SVC isolation (SVCI) versus PVI alone in terms of AF recurrence, procedure-related complications, and fluoroscopic and procedural times.
METHODS: A search of online scientific libraries (from inception to April 1, 2024) was performed. Four RCTs were considered eligible for the meta-analysis totaling 600 patients of whom 287 receiving PVI + SVCI and 313 receiving PVI alone.
RESULTS: In the overall population, SVCI + PVI was associated with a non-significant reduction of AF recurrence at follow-up (0.66 [0.43;1.00], p = 0.05, I2 0%). In patients with paroxysmal AF (PAF), a significant reduction of AF recurrence was related to SVCI + PVI (11.7%) as compared to PVI alone (19.9%) (0.54 [0.32;0.92], p = 0.02, I2 0%). No statistical differences were found among the groups in terms of fluoroscopic (3.31 [- 0.8;7.41], p = 0.11, I2 = 91%), procedural times (5.69 [- 9.78;21.16], p = 0.47, I2 = 81%), and complications (1.06 [0.33;3.44], p = 0.92, I2 = 0%).
CONCLUSIONS: The addition of SVCI to PVI in patients in PAF is associated with a significant lower rate of AF recurrence at follow-up, without increasing complication rates and procedural and fluoroscopy times.
摘要：
背景：肺静脉隔离（PVI）的长期成功率是次优的，因为非肺静脉（PV）病灶的存在可以触发高达11％的房颤（AF）。在非PV触发器中，上腔静脉（SVC）是引发房颤的异位搏动的主要来源。
目的：比较评估PVI+经验性SVC分离（SVCI）与单纯PVI在房颤复发方面的随机对照试验（RCT）的数据，手术相关并发症,以及透视和手术时间。
方法：搜索在线科学图书馆（从开始到2024年4月1日）。四个RCT被认为符合荟萃分析的条件，共有600名患者，其中287名患者接受PVI+SVCI，313名患者仅接受PVI。
结果：在总体人口中，在随访时,SVCI+PVI与房颤复发无显著减少相关(0.66[0.43;1.00],p=0.05，I20%）。在阵发性房颤（PAF）患者中，与单纯PVI（19.9%）相比，房颤复发显著减少与SVCI+PVI（11.7%）相关（0.54[0.32;0.92]，p=0.02，I20%)。在透视方面，各组之间无统计学差异（3.31[-0.8;7.41]，p=0.11,I2=91%),程序时间(5.69[-9.78；21.16]，p=0.47，I2=81%)，和并发症（1.06[0.33；3.44]，p=0.92，I2=0%）。
结论：在PAF患者的PVI中添加SVCI与随访时房颤复发率的降低有关。没有增加并发症发生率和手术和透视时间。
目的：比较评估PVI+经验性SVC分离（SVCI）与单纯PVI在房颤复发方面的随机对照试验（RCT）的数据，手术相关并发症,以及透视和手术时间。
方法：搜索在线科学图书馆（从开始到2024年4月1日）。四个RCT被认为符合荟萃分析的条件，共有600名患者，其中287名患者接受PVI+SVCI，313名患者仅接受PVI。
结果：在总体人口中，在随访时,SVCI+PVI与房颤复发无显著减少相关(0.66[0.43;1.00],p=0.05，I20%）。在阵发性房颤（PAF）患者中，与单纯PVI（19.9%）相比，房颤复发显著减少与SVCI+PVI（11.7%）相关（0.54[0.32;0.92]，p=0.02，I20%)。在透视方面，各组之间无统计学差异（3.31[-0.8;7.41]，p=0.11,I2=91%),程序时间(5.69[-9.78；21.16]，p=0.47，I2=81%)，和并发症（1.06[0.33；3.44]，p=0.92，I2=0%）。
结论：在PAF患者的PVI中添加SVCI与随访时房颤复发率的降低有关。没有增加并发症发生率和手术和透视时间。
