UNASSIGNED:室性心动过速(VT)的导管消融术(CA)可以改善缺血性心肌病患者的预后。非缺血性心肌病患者的数据很少。本系统评价和荟萃分析的目的是比较缺血性或非缺血性心肌病患者早期CA的VT与延迟或无消融。
UASSIGNED:根据以下PICOS标准选择研究:患有结构性心脏病和可植入心脏复律除颤器(ICD)的室性心动过速患者,不考虑抗心律失常药物治疗;干预-早期CA;比较-无或延迟CA;结果-任何适当的ICD治疗,适当的ICD冲击,全因死亡率,VT风暴,心血管死亡率,心血管住院,并发症,生活质量;已发表随访≥12个月的随机试验。进行随机效应荟萃分析。使用汇总的研究水平数据评估结果,并报告为比值比(OR)或具有95%置信区间(CI)的平均差。还进行了左心室射血分数(LVEF)的分层。8项试验(n=1,076)符合标准。早期消融与ICD治疗发生率降低相关(OR0.53,95%CI0.33-0.83,p=0.005),冲击(OR0.52,95%CI0.35-0.77,p=0.001),VT风暴(OR0.58,95%CI0.39-0.85,p=0.006),和心血管住院(OR0.67,95%CI0.49-0.92,p=0.01)。全因死亡率和心血管死亡率,并发症,和生活质量没有什么不同。LVEF分层显示仅在较高EF时ICD治疗减少(高EFOR0.40,95%CI0.20-0.80,p=0.01vs.低EFOR0.62,95%CI0.34-1.12,p=0.11),而ICD冲击(高EFOR0.54,95%CI0.25-1.15,p=0.11与低EFOR0.50,95%CI0.30-0.83,p=0.008)和住院率(高EFOR0.95,95%CI0.58-1.58,p=0.85vs.低EFOR0.58,95%CI0.40-0.82,p=0.002)仅在EF较低的患者中降低。
UNASSIGNED:结构性心脏病患者早期CA治疗室性心动过速与ICD治疗和电击发生率降低相关,VT风暴,和住院。对死亡率没有影响,并发症,和生活质量。(审查协议于2022年6月19日在INPLASY注册,#202260080)。
UNASSIGNED:[https://inplasy.com/],标识符[202260080]。
UNASSIGNED: Catheter ablation (CA) for ventricular tachycardia (VT) can improve outcomes in patients with ischemic cardiomyopathy. Data on patients with non-ischemic cardiomyopathy are scarce. The purpose of this systematic
review and meta-analysis is to compare early CA for VT to deferred or no ablation in patients with ischemic or non-ischemic cardiomyopathy.
UNASSIGNED: Studies were selected according to the following PICOS criteria: patients with structural heart disease and an implantable cardioverter-defibrillator (ICD) for VT, regardless of the antiarrhythmic drug treatment; intervention-early CA; comparison-no or deferred CA; outcomes-any appropriate ICD therapy, appropriate ICD shocks, all-cause mortality, VT storm, cardiovascular mortality, cardiovascular hospitalizations, complications, quality of life; published randomized trials with follow-up ≥12 months. Random-effect meta-analysis was performed. Outcomes were assessed using aggregate study-level data and reported as odds ratio (OR) or mean difference with 95% confidence intervals (CIs). Stratification by left ventricular ejection fraction (LVEF) was also done. Eight trials (n = 1,076) met the criteria. Early ablation was associated with reduced incidence of ICD therapy (OR 0.53, 95% CI 0.33-0.83, p = 0.005), shocks (OR 0.52, 95% CI 0.35-0.77, p = 0.001), VT storm (OR 0.58, 95% CI 0.39-0.85, p = 0.006), and cardiovascular hospitalizations (OR 0.67, 95% CI 0.49-0.92, p = 0.01). All-cause and cardiovascular mortality, complications, and quality of life were not different. Stratification by LVEF showed a reduction of ICD therapy only with higher EF (high EF OR 0.40, 95% CI 0.20-0.80, p = 0.01 vs. low EF OR 0.62, 95% CI 0.34-1.12, p = 0.11), while ICD shocks (high EF OR 0.54, 95% CI 0.25-1.15, p = 0.11 vs. low EF OR 0.50, 95% CI 0.30-0.83, p = 0.008) and hospitalizations (high EF OR 0.95, 95% CI 0.58-1.58, p = 0.85 vs. low EF OR 0.58, 95% CI 0.40-0.82, p = 0.002) were reduced only in patients with lower EF.
UNASSIGNED: Early CA for VT in patients with structural heart disease is associated with reduced incidence of ICD therapy and shocks, VT storm, and hospitalizations. There is no impact on mortality, complications, and quality of life. (The
review protocol was registered with INPLASY on June 19, 2022, #202260080).
UNASSIGNED: [https://inplasy.com/], identifier [202260080].