目的:本荟萃分析旨在根据钆增强磁共振成像(LGE-MRI)的不同纤维化阶段,研究消融后房颤(AF)的复发情况。
方法:使用特定术语搜索电子数据库,并确定符合纳入标准的9项研究。共有1,787例患者在房颤导管消融术前接受了LGE-MRI评估心房纤维化。我们进行了三项分析:首先,我们比较了IV期与I期(参照组).第二组检查了III和IV阶段与I和II阶段的组合(参考组)。第三组比较了第四阶段和合并的第一阶段,II,和III。元分析依赖于随机效应模型,使用DerSimonian和Laird方法汇集优势比(OR)和95%置信区间(CI)。在英格兰使用StatsDirect软件分析数据。
结果:该研究表明,与I期相比,IV期心房纤维化消融后房颤复发率更高(OR,9.54;95%CI,3.81至28.89;P<00001)。此外,在心房纤维化III和IV期合并的患者中,消融术后房颤复发率明显高于I期和II期(OR,2.37;95%CI,1.61至3.50;P<00001)。同样,与组合阶段I相比,II,III,IV期患者在消融后复发的几率更高(OR,4.24;95%CI,2.39-7.52,P<0.001)。
结论:本元分析显示,LGE-MRI左房纤维化与房颤消融术后复发之间存在强关联。这项研究的发现将进一步帮助临床医生根据纤维化的数量预测房颤的复发率,并为进一步的管理制定治疗决策。
This meta-analysis aims to investigate the recurrence of atrial fibrillation (AF) post-ablation based on the various stages of fibrosis seen in the late gadolinium enhancement magnetic resonance imaging (LGE-MRI).
Electronic databases were searched using specific terms and identified nine studies that met the inclusion criteria. A total of 1,787 patients underwent LGE-MRI to assess atrial fibrosis before catheter ablation for AF. We performed three analyses: first, we compared stage IV versus stage I (reference group). The second set examined the combined stages III and IV versus stages I and II (reference group). The third set compared stage IV versus combined stages I, II, and III. The metanalysis relied on a random-effects model to pool the odds ratios (OR) and 95% confidence intervals (CI) using the DerSimonian and Laird method. The data was analyzed using StatsDirect software in England.
The study showed a higher rate of AF recurrence after ablation in stage IV atrial fibrosis than in stage I (OR, 9.54; 95% CI, 3.81 to 28.89; P<00001). Also, in patients with combined stages III & IV of atrial fibrosis, AF recurrence was significantly higher after ablation than in stages I & II groups (OR, 2.37; 95% CI, 1.61 to 3.50; P<00001). Similarly, compared to combined stages I, II, and III, patients with stage IV have higher odds of recurrence post-ablation (OR, 4.24; 95% CI, 2.39- 7.52, P < 0.001).
This metanalysis demonstrates the strong association between left atrial fibrosis in LGE-MRI and AF post-ablation recurrence. The finding of this study will further assist clinicians in predicting the recurrence rate of AF based on the amount of fibrosis and tailor therapeutic decisions for further management.