Spector Peter, Reynolds Matthew R, Calkins Hugh, Sondhi Manu, Xu Yingxin, Martin Amber, Williams Catherine J, Sledge Isabella
University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA.
Am J Cardiol. 2009 Sep 1;104(5):671-7. doi: 10.1016/j.amjcard.2009.04.040.
The purpose of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of radiofrequency ablation (RFA) of typical atrial flutter (AFL) and atrioventricular node-dependent supraventricular tachycardia (SVT) in adult patients. Medline and EMBASE were searched (1990 to 2007) for all study design trials of RFA. Data relating to single- and multiple-procedure success, arrhythmia recurrence, repeat ablation, adverse events, and death were extracted. For RFA in AFL, 18 primary studies with 22 treatment arms and 1,323 patients were identified. Single-procedure success for AFL was 91.7% (95% confidence interval [CI] 88.4% to 94.9%). Multiple-procedure success was 97.0% (95% CI 94.7% to 99.4%). Postablation arrhythmia was noted in 13.2% of patients (95% CI 7.5% to 18.9%), while repeat ablation was reported in 8% (95% CI 4.5% to 11.4%). For RFA of SVT, 39 primary studies with 49 treatment arms in 7,693 patients with accessory pathways and atrioventricular nodal reentrant tachycardia were identified. Single-procedure success for SVT was 93.2% (95% CI 90.8% to 95.5%). Multiple-procedure success was 94.6% (95% CI 92.4% to 96.9). Postablation arrhythmia was noted in 5.6% patients (95% CI 4.1% to 7.2%). Repeat ablation occurred in 6.5% (95% CI 4.7% to 8.3%). For AFL studies, all-cause mortality was 0.6%, and adverse events were reported in 0.5% of patients. For SVT studies, all-cause mortality was 0.1%, and adverse events were reported in 2.9% of patients. In conclusion, studies of RFA for the treatment of patients with AFL and SVT report high efficacy rates and low rates of complications.
本研究旨在进行一项系统评价和荟萃分析，以评估成人患者典型心房扑动（AFL）和房室结依赖性室上性心动过速（SVT）的射频消融（RFA）的安全性和有效性。检索了Medline和EMBASE（1990年至2007年）中所有关于RFA的研究设计试验。提取了与单次和多次手术成功率、心律失常复发、重复消融、不良事件和死亡相关的数据。对于AFL的RFA，确定了18项主要研究，有22个治疗组和1323例患者。AFL的单次手术成功率为91.7%（95%置信区间[CI]88.4%至94.9%）。多次手术成功率为97.0%（95%CI 94.7%至99.4%）。13.2%的患者出现消融后心律失常（95%CI 7.5%至18.9%），而8%的患者进行了重复消融（95%CI 4.5%至11.4%）。对于SVT的RFA，确定了39项主要研究，有49个治疗组，涉及7693例有旁路和房室结折返性心动过速的患者。SVT的单次手术成功率为93.2%（95%CI 90.8%至95.5%）。多次手术成功率为94.6%（95%CI 92.4%至96.9%）。5.6%的患者出现消融后心律失常（95%CI 4.1%至7.2%）。6.5%的患者进行了重复消融（95%CI 4.7%至8.3%）。对于AFL研究，全因死亡率为0.6%，0.5%的患者报告有不良事件。对于SVT研究，全因死亡率为0.1%，2.9%的患者报告有不良事件。总之，RFA治疗AFL和SVT患者的研究报告了高有效率和低并发症发生率。
