Calkins Hugh, Reynolds Matthew R, Spector Peter, Sondhi Manu, Xu Yingxin, Martin Amber, Williams Catherine J, Sledge Isabella
Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Circ Arrhythm Electrophysiol. 2009 Aug;2(4):349-61. doi: 10.1161/CIRCEP.108.824789. Epub 2009 Jun 2.
Although radiofrequency catheter ablation (RFA) has evolved from an experimental procedure to an important treatment option for atrial fibrillation, the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug (AAD) therapy has not been established.
Two separate systematic reviews were conducted: one on RFA and the other on AAD to provide accurate and broadly representative estimates of the clinical efficacy and safety of both therapies in the treatment of atrial fibrillation. Electronic searches were conducted in EMBASE and MEDLINE from 1990 to 2007. For the RFA review, all study designs were accepted. For the AAD review, articles were limited to prospective studies on the following drugs of interest: amiodarone, dofetilide, sotalol, flecainide, and propafenone. Data were extracted by 1 reviewer, with a second reviewer performing independent confirmation of extracted data. Sixty-three RFA and 34 AAD studies were included in the reviews. Patients enrolled in RFA studies tended to be younger (mean age, 55 versus 62 years), had longer duration of atrial fibrillation (6.0 versus 3.1 years), and had failed a greater number of prior drug trials (2.6 versus 1.7). The single-procedure success rate of ablation off AAD therapy was 57% (95% CI, 50% to 64%), the multiple procedure success rate off AAD was 71% (95% CI, 65% to 77%), and the multiple procedure success rate on AAD or with unknown AAD usage was 77% (95% CI, 73% to 81%). In comparison, the success rate for AAD therapy was 52% (95% CI, 47% to 57%). A major complication of catheter ablation occurred in 4.9% of patients. Adverse events for AAD studies, although more common (30% versus 5%), were less severe.
Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications.
尽管射频导管消融术（RFA）已从一种实验性手术发展成为心房颤动的一种重要治疗选择，但相对于抗心律失常药物（AAD）治疗，导管消融术的相对安全性和有效性尚未确定。
进行了两项独立的系统评价：一项关于RFA，另一项关于AAD，以准确且广泛地代表两种治疗方法治疗心房颤动的临床疗效和安全性。于1990年至2007年在EMBASE和MEDLINE中进行电子检索。对于RFA评价，接受所有研究设计。对于AAD评价，文章限于对以下感兴趣药物的前瞻性研究：胺碘酮、多非利特、索他洛尔、氟卡尼和普罗帕酮。由1名评价者提取数据，第二名评价者对提取的数据进行独立确认。评价纳入了63项RFA研究和34项AAD研究。纳入RFA研究的患者往往更年轻（平均年龄55岁对62岁），心房颤动持续时间更长（6.0年对3.1年），并且先前药物试验失败的次数更多（2.6次对1.7次）。停用AAD治疗的单次手术成功率为57%（95%CI，50%至64%），停用AAD的多次手术成功率为71%（95%CI，65%至77%），使用AAD或AAD使用情况未知时的多次手术成功率为77%（95%CI，73%至81%）。相比之下，AAD治疗的成功率为52%（95%CI，47%至57%）。4.9%的患者发生了导管消融的主要并发症。AAD研究的不良事件虽然更常见（30%对5%），但严重程度较低。
治疗心房颤动的RFA研究报告的有效率高于AAD治疗研究，且并发症发生率较低。
