Noheria Amit, Kumar Abhishek, Wylie John V, Josephson Mark E
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Arch Intern Med. 2008 Mar 24;168(6):581-6. doi: 10.1001/archinte.168.6.581.
Circumferential pulmonary vein ablation (CPVA) has become common therapy for atrial fibrillation (AF), but results of large randomized controlled trials comparing this procedure with antiarrhythmic drug therapy (ADT) have not been published to date. We conducted a systematic literature review to assess whether CPVA is superior to ADT for the management of AF.
We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. Data were abstracted to construct a 2 x 2 table for each trial. Recurrence of any atrial tachyarrhythmia (AT) was considered the primary end point of the trials. The estimate and confidence interval for the pooled risk ratio of AT recurrence-free survival in the CPVA group vs the ADT group were obtained using the random-effects model.
Four trials qualified for the meta-analysis. In total, 162 of 214 patients (75.7%) in the CPVA group had AT recurrence-free survival vs 41 of 218 patients (18.8%) in the ADT group. The random-effects pooled risk ratio for AT recurrence-free survival was 3.73 (95% confidence interval, 2.47-5.63). In addition, fewer adverse events were reported in the CPVA group compared with that in the ADT group.
We observed statistically significantly better AT recurrence-free survival with CPVA than with ADT. These results highlight the need for larger trials to determine the appropriate role for CPVA in the management of AF. Ongoing clinical trials may provide further guidance on these treatment options for AF.
环肺静脉消融术（CPVA）已成为心房颤动（AF）的常见治疗方法，但迄今为止，尚无比较该手术与抗心律失常药物治疗（ADT）的大型随机对照试验结果发表。我们进行了一项系统的文献综述，以评估CPVA在房颤管理方面是否优于ADT。
我们在PubMed、EMBASE和Cochrane对照试验中央注册库中检索相关随机对照试验。提取数据为每个试验构建一个2×2表格。任何房性快速心律失常（AT）的复发被视为试验的主要终点。使用随机效应模型获得CPVA组与ADT组无AT复发存活的合并风险比的估计值和置信区间。
四项试验符合荟萃分析条件。CPVA组214例患者中有162例（75.7%）无AT复发存活，而ADT组218例患者中有41例（18.8%）。无AT复发存活的随机效应合并风险比为3.73（95%置信区间，2.47 - 5.63）。此外，与ADT组相比，CPVA组报告的不良事件更少。
我们观察到CPVA组的无AT复发存活在统计学上显著优于ADT组。这些结果凸显了需要进行更大规模试验以确定CPVA在房颤管理中的适当作用。正在进行的临床试验可能会为房颤的这些治疗选择提供进一步指导。
