心房颤动肺静脉电隔离与附加碎裂电位消融疗效比较的Meta分析  

Efficacy and safety of adjunctive ablation of complex fractionated atrial electrograms and pulmonary vein isolation in patients with atrial fibrillation:a meta-analysis

作　　者：文俊杰[1] 罗素新[1] 易光兆[1] 何泉[1] 周泓羽[1] 

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016

出　　处：《第三军医大学学报》2014年第2期177-183,共7页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81270210);国家临床重点专科建设项目(2011-08)~~

摘　　要：目的评价首次肺静脉电隔离与附加心房碎裂电位消融在心房颤动（简称房颤）治疗中的临床疗效及安全性。方法用计算机加手工检索数据库（Pubmed、CochraneLibrary、EMbase、Elsvier、中国生物医学文献、知网、维普）中关于肺静脉电隔离与附加心房碎裂电位消融在房颤治疗的从1980年1月至2012年9月的对照试验，并追溯纳入研究的参考文献，采用RevMan5．1软件进行分析。结果最终纳入了12篇符合标准的文献，共包含1131例患者。Meta分析结果显示：房颤附加心房碎裂电位消融较单纯肺静脉电隔离能增加术后窦性心律维持率（RR为1．17，95％CI为1．04～1．32，P=0．008），可提高阵发性房颤亚组（RR为1．12，95％CI为1．01～1．24，P=0．03）及持续性房颤亚组（RR为1．32，95％C1为1．14—1．53，P=0．0003）窦性心律维持率，但附加碎裂电位消融会增加手术时间、x线暴露时间和消融时间，2组手术相关并发症差异无统计学意义（P=0．85）。结论房颤治疗中附加心房碎裂电位消融与单纯肺静脉电隔离比较可以增加窦性心律的维持率，但增加手术时间、x线暴露时间和消融时间，附加心房碎裂电位消融风险／获益比还需更大规模的长期随访来评价。Objective To compare the efficacy and safety of pulmonary vein isolation （PVI） versus PVI plus adjunctive ablation of complex fractionated atrial electrograms （CFAEs） in patients with atrial fibrilla- tion （AF） after a single procedure. Methods Literature search was conducted in PubMed, EMBASE, Cochrane Library, CBM, Elsevier, CNKI and VIP for the clinical controlled trials of PVI versus PVI plus adjunctive ablation of CFAEs in patients with AF, from January 1,1980 to August 31,2012. The references in the included literature were also retrieved. The extracted data were analyzed using RevMan 5. 1 software. Results Twelve qualified trials involving 1 131 AF patients were included. The results of meta-analysis showed that： in an overall pooled estimation, compared with PVI alone, the rates of sinus rhythm maintenance （RR = 1.17, 95% CI = 1.04 to 1.32, P =0. 008） were increased by PVI plus adjunctive ablation of CFAEs. Subgroup analysis demonstrated that PVI plus adjunctive ablation of CFAEs increased the rates of sinus rhythm maintenance in paroxysmal AF （RR = 1.12, 95% CI = 1.01 to 1.24, P =0. 03） and persistent AF （RR = 1.32, 95% CI = 1. 14 to 1.53, P =0. 000 3）. Adjunctive ablation of CFAEs significantly increased mean procedural, mean fluoroscopy, and mean radiofrequeney （RF） application time. The incidence of complica- tions was not significantly different between the two groups （P = 0. 85 ）. Conclusion PV1 followed by adjunc- tive ablation of CFAEs increases the rate of long-term sinus rhythm maintenance in patients. Adjunctive ablation of CFAEs increases procedural, fluoroscopy, and RF application time. The risk/benefit profile of adjunctive ablation of CFAEs needs further evaluation with additional studies and long-term follow-up.

关 键 词：心房颤动 导管消融 心房碎裂电位 肺静脉隔离 META分析 

分 类 号：R181.23[医药卫生—流行病学] R454.1[医药卫生—公共卫生与预防医学]