Upadhyay Gaurav A, Choudhry Niteesh K, Auricchio Angelo, Ruskin Jeremy, Singh Jagmeet P
Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Am Coll Cardiol. 2008 Oct 7;52(15):1239-46. doi: 10.1016/j.jacc.2008.06.043.
This study is a meta-analysis of prospective cohort studies comparing the impact of cardiac resynchronization therapy (CRT) for patients in atrial fibrillation (AF) and sinus rhythm (SR).
Although close to one-third of advanced heart failure patients exhibit AF, the impact of CRT in this group remains unclear.
Prospective cohort studies comparing patients in normal SR and chronic AF treated with CRT were included. All studies reported death, New York Heart Association functional class, ejection fraction, 6-min walk test, and the Minnesota score or its equivalent as outcomes. Data sources included Ovid MEDLINE In-Process & Other Non-Indexed Citations, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects, and the American College of Physicians Journal Club.
Of 2,487 reports identified, 5 studies following a total of 1,164 patients were included. Both AF and SR patients benefited significantly from CRT. Mortality was not significantly different at 1 year (relative risk ratio: 1.57, 95% confidence interval [CI]: 0.87 to 2.81). The New York Heart Association functional class improved similarly for both groups (-0.90 for SR patients, -0.84 for AF patients). SR patients showed greater relative improvement in the 6-min walk test (11.6 m greater, 95% CI: 10.4 to 12.8 m) and the Minnesota score (3.9 points less, 95% CI: 3.4 to 4.5 points) than AF patients. AF patients, however, achieved a small but statistically significant greater change in ejection fraction (0.39% greater change in ejection fraction, 95% CI: 0.22% to 0.55%).
Patients in AF show significant improvement after CRT, with similar or improved ejection fraction as SR patients, but smaller benefits in regard to functional outcomes.
本研究是一项前瞻性队列研究的荟萃分析，比较心脏再同步治疗（CRT）对心房颤动（AF）患者和窦性心律（SR）患者的影响。
尽管近三分之一的晚期心力衰竭患者表现为AF，但CRT对该组患者的影响仍不明确。
纳入比较接受CRT治疗的正常SR患者和慢性AF患者的前瞻性队列研究。所有研究均报告了死亡、纽约心脏协会功能分级、射血分数、6分钟步行试验以及明尼苏达评分或其等效指标作为结局。数据来源包括Ovid MEDLINE在研及其他未索引引文、Cochrane对照试验中心注册库、效果评价摘要数据库和美国医师学会杂志俱乐部。
在识别出的2487份报告中，纳入了5项研究，共1164例患者。AF患者和SR患者均从CRT中显著获益。1年时死亡率无显著差异（相对风险比：1.57，95%置信区间[CI]：0.87至2.81）。两组纽约心脏协会功能分级的改善相似（SR患者为-0.90，AF患者为-0.84）。与AF患者相比，SR患者在6分钟步行试验（多11.6米，95%CI：10.4至12.8米）和明尼苏达评分（少3.9分，95%CI：3.4至4.5分）方面显示出更大的相对改善。然而，AF患者在射血分数方面实现了虽小但具有统计学意义的更大变化（射血分数变化大0.39%，95%CI：0.22%至0.55%）。
AF患者在CRT后显示出显著改善，射血分数与SR患者相似或有所改善，但在功能结局方面获益较小。
