背景:导管消融和抗心律失常药物治疗用于心房颤动(AF)的心律控制,但是它们的相对有效性,尤其是当代的治疗方式,仍然未定义。我们进行了系统评价和荟萃分析,对比了目前的消融技术和抗心律失常药物治疗房颤。
方法:我们搜索了PubMed,Scopus,科克伦中部,和WebofScience直到2023年11月进行比较房颤导管消融与抗心律失常药物的随机试验,对抗单独的抗心律失常药物治疗,报告>6个月的结果。四名调查人员提取数据并用ROB2工具评估偏倚风险(ROB)。荟萃分析使用R软件估计合并的疗效和安全性结果。
结果:12项试验(n=3977)符合纳入标准。导管消融术与较低的房颤复发相关(相对危险度(RR)=0.44,95CI(0.33,0.59),P<0.0001)和住院(RR=0.44,95CI(0.23,0.82),P=0.009)比抗心律失常药物。导管消融术还使身体生活质量部分评分(通过36项简短表格调查评估)提高了7.61分(95CI-0.70-15.92,P=0.07);但是,由于高度异质性,没有统计学意义。消融与更高的手术相关并发症显著相关[RR=15.70,95CI(4.53,54.38),P<0.0001]和心脏压塞[RR=9.22,95CI(2.16,39.40),P=0.0027]。两组的全因死亡率相似。
结论:对于有症状的房颤,前期导管消融术比单纯继续药物治疗更能减少心律失常和住院,尽管有中度更多的不良事件。关于消融术的时机,需要谨慎的患者选择和风险收益评估。
BACKGROUND: Catheter ablation and antiarrhythmic drug therapy are utilized for rhythm control in atrial fibrillation (AF), but their comparative effectiveness, especially with contemporary treatment modalities, remains undefined. We conducted a systematic
review and meta-analysis contrasting current ablation techniques against antiarrhythmic medications for AF.
METHODS: We searched PubMed, SCOPUS, Cochrane CENTRAL, and Web of Science until November 2023 for randomized trials comparing AF catheter ablation with antiarrhythmics, against antiarrhythmic drug therapy alone, reporting outcomes for > 6 months. Four investigators extracted data and appraised risk of bias (ROB) with ROB 2 tool. Meta-analyses estimated pooled efficacy and safety outcomes using R software.
RESULTS: Twelve trials (n = 3977) met the inclusion criteria. Catheter ablation was associated with lower AF recurrence (relative risk (RR) = 0.44, 95%CI (0.33, 0.59), P ˂ 0.0001) and hospitalizations (RR = 0.44, 95%CI (0.23, 0.82), P = 0.009) than antiarrhythmic medications. Catheter ablation also improved the physical quality of life component score (assessed by a 36-item Short Form survey) by 7.61 points (95%CI -0.70-15.92, P = 0.07); but, due to high heterogeneity, it was not statistically significant. Ablation was significantly associated with higher procedural-related complications [RR = 15.70, 95%CI (4.53, 54.38), P < 0.0001] and cardiac tamponade [RR = 9.22, 95%CI (2.16, 39.40), P = 0.0027]. All-cause mortality was similar between the two groups.
CONCLUSIONS: For symptomatic AF, upfront catheter ablation reduces arrhythmia and hospitalizations better than continued medical therapy alone, albeit with moderately more adverse events. Careful patient selection and risk-benefit assessment are warranted regarding the timing of ablation.