■与室间隔肌切除术(SM)相比,酒精室间隔消融术(ASA)更常用于内科难治性肥厚型梗阻性心肌病(HOCM),然而,其产生致心律失常底物的潜力增加.
■在PubMed中进行了系统搜索,EMBASE,WebofScience,和Cochrane图书馆从成立到2020年10月。使用固定或随机效应模型来估计SM和ASA队列之间室性心律失常事件或其他结果的风险比(RR)。
■20项研究纳入8025例患者。池分析显示,室性心动过速(VT)/室颤(VF)的发生率,其中包括适当的植入式心律转复除颤器(ICD)干预,ASA队列明显高于SM队列(ASAvsSM:10%(345/3312)vs5%(161/3227)(RR=1.98,95%CI(置信区间),1.65-2.37;p<0.00001,I2=0%)。在这两组中,超过90%的室性心动过速/室颤事件发生在早期阶段(术中,住院期间或术后30天内)(ASA:94.20%;SM:94.41%)。进一步的亚组分析还显示,在早期阶段(RR=1.94,95%CI,1.61-2.33;p<0.0001,I2=0%)和晚期阶段(RR=2.80,95%CI,1.00-7.89;p=0.05,I2=33%),ASA组的VT/VF发生率均较高。此外,尽管ASA和SM组之间心源性猝死(SCD)的风险相似,心脏骤停(SCA)的发生率较高,其中包括SCD和复苏的SCA,在ASA组中观察到(RR=2.30,95%CI,1.35-3.94;p=0.002,I2=0%)。
■在HOCM患者中,接受ASA治疗的患者VF/VT和SCD合并SCA复苏的发生率较高.大多数VT/VF发生在早期。
UNASSIGNED: Alcohol septal ablation (ASA) has been more commonly applied in medical refractory hypertrophic obstructive cardiomyopathy (HOCM) compared with septal myectomy (SM), however its potential to create a proarrhythmic substrate is increased.
UNASSIGNED: A systematic search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to October 2020. Fixed or random effects models were used to estimate the risk ratios (RR) for ventricular arrhythmia events or other outcomes between the SM and ASA cohorts.
UNASSIGNED: Twenty studies with 8025 patients were included. Pool analysis showed that the incidence of ventricular tachycardia (VT)/ventricular fibrillation (VF), which included appropriate implantable cardioverter defibrillator (ICD) intervention, was significantly higher in the ASA cohort than that in the SM cohort (ASA vs SM: 10% (345/3312) vs 5% (161/3227) (RR = 1.98, 95% CI (confidence interval), 1.65-2.37; p < 0.00001, I 2 = 0%). In both groups, more than 90% of VT/VF events occurred in the early phase (during the procedure, during hospitalization or within 30 days after the procedure) (ASA: 94.20%; SM: 94.41%). Further subgroup analysis also showed that the ASA group had a higher incidence of VT/VF in both the early phase (RR = 1.94, 95% CI, 1.61-2.33; p < 0.0001, I 2 = 0%) and the late phase (RR = 2.80, 95% CI, 1.00-7.89; p = 0.05, I 2 = 33%). Furthermore, although the risks of sudden cardiac death (SCD) were similar between the ASA and SM groups, a higher incidence of sudden cardiac arrest (SCA), which included SCD and resuscitated SCA, was observed in the ASA group (RR = 2.30, 95% CI, 1.35-3.94; p = 0.002, I 2 = 0%).
UNASSIGNED: In patients with HOCM, those who received ASA showed a higher incidence of VF/VT and SCD combined with resuscitated SCA. The majority of VT/VF occurred in the early phase.