房颤导管消融术后应用抗心律失常药物对维持窦性心律的有效性的Meta分析  

Meta analysis of the effectiveness of antiarrhythmic drugs after catheter ablation of atrial fibrillation

作　　者：贾鹤 于波[1] 佟文君 赫凯 杜奥林 JIA He;YU Bo;TONG Wenjun;HE Kai;DU Aolin(Department of Cardiology,The First Hospital of China Medical University,Shenyang,110000,China)

机构地区：[1]中国医科大学附属第一医院心内科,沈阳110000

出　　处：《临床心血管病杂志》2020年第12期1141-1146,共6页Journal of Clinical Cardiology

基　　金：辽宁省心源性卒中预防及基层医院培训指导策略研究(No:2019JH6/10400005)。

摘　　要：目的:系统评价心房颤动(房颤)导管消融术后应用抗心律失常药物对维持窦性心律的有效性。方法:系统检索PubMed、Cochrane Central Register of Controlled Trials及EMBASE数据库,搜集关于导管消融术后应用抗心律失常药物的随机对照试验(RCT),检索时限限制为从建库至2019年6月。由两名研究者独立进行文献筛选、资料提取以及研究偏倚风险的评价,而后采用RevMan 5.3软件进行Meta分析。结果:总计纳入16个RCT。Meta分析结果显示:与未应用抗心律失常药物组相比,导管消融术后应用抗心律失常药物组可以降低空白期房性心律失常事件的发生率[OR=0.60,95%CI:(0.41,0.87),P<0.01],降低远期复发率[OR=0.83,95%CI:(0.71,0.97),P=0.02]。Ⅲ类抗心律失常药物可以显著降低远期复发率[OR=0.62,95%CI:(0.41,0.93),P=0.02]。而ⅠC类抗心律失常药物对复发的影响未见显著差异[OR=0.87,95%CI:(0.40,1.91),P=0.73]。结论:现有证据表明术后应用抗心律失常药物与低复发率显著相关,Ⅲ类抗心律失常药物的作用更加明显。Objective:To systematically evaluate the effectiveness of antiarrhythmic drugs for maintaining sinus rhythm after AF catheter ablation.Method:The PubMed,Cochrane Central Register of Controlled Trials and EMBASE databases were systematically searched.Randomized controlled trials(RCTs)of antiarrhythmic drugs after catheter ablation were collected.The search period was limited from the establishment of the database to June 2019.Two researchers independently performed literature screening,data extraction,and evaluation of the risk of research bias,and then performed Meta analysis using RevMan 5.3 software.Result:A total of 16 RCTs were included.The meta-analysis results showed that compared with the group without antiarrhythmic drugs,the application of antiarrhythmic drugs after catheter ablation can reduce the incidence of atrial arrhythmia in the blank period(OR=0.60,95%CI:[0.41,0.87],P<0.01),reducing the long-term recurrence rate(OR=0.83,95%CI:[0.71,0.97],P=0.02).Class III antiarrhythmic drugs can significantly reduce the long-term recurrence rate(OR=0.62,95%CI:[0.41,0.93],P=0.02).There was no significant difference in the effects of IC antiarrhythmic drugs on recurrence(OR=0.87,95%CI:[0.40,1.91],P=0.73).Conclusion:Existing evidence indicates that the use of antiarrhythmic drugs after surgery is significantly associated with a low recurrence rate,and the effect of class III antiarrhythmic drugs is more significant.

关 键 词：心房颤动 导管消融 抗心律失常药物 META分析 随机对照试验 

分 类 号：R541.7[医药卫生—心血管疾病]