Department of Internal Medicine, University of Connecticut, Farmington, CT, USA.
Am J Ther. 2012 Jan;19(1):e18-20. doi: 10.1097/MJT.0b013e3181e7a501.
Symptomatic atrial fibrillation is often treated with antiarrhythmic drugs. Responsiveness is poor and adverse effects common. Nonpharmacologic treatments consisting of the Maze procedure and catheter-based pulmonary vein isolation are highly successful but invasive with complications. Right atrial ablation is relatively simple in comparison. Success ranges between 20% and 80%. Some studies have shown improved response when combined with antiarrhythmic drugs (AADs). We performed a review of available literature to determine the efficacy of hybrid therapy in the form of right atrial ablation, AAD with cardioversion, and pacing in reducing atrial fibrillation burden. All human studies studying efficacy of right atrial ablation and postablation AAD therapy in refractory atrial fibrillation were considered. The primary outcome was reduction of atrial fibrillation burden. The secondary outcome was significant adverse events. We searched Medline, EMBASE, CINAHL, and Cochrane databases. Data collection, analysis, and selection of studies were done independently by two review authors. We included six studies with variable numbers of participants and outcomes. We defined success of hybrid therapy as reduced burden of atrial fibrillation. Total subjects studied was 189, 26% female and 74% male. Average age was 58 years. Left atrial diameter was less than 5 cm and mean ejection fraction was 64%. Mean atrial fibrillation duration was 3.35 years. Most patients had failed at least two AADs. Hybrid therapy was successful in 82% patients. All forms of hybrid therapy consisting of right atrial ablation and AAD therapy seem to be reasonably effective in relief of symptoms from refractory atrial fibrillation with minimal side effects; however, much larger randomized trials need to be performed before a significant superiority of any one may be established.
症状性心房颤动通常用抗心律失常药物治疗。反应不佳且常见不良反应。由迷宫手术和导管肺静脉隔离组成的非药物治疗非常成功，但具有侵入性且伴有并发症。相比之下，右心房消融术相对简单。成功率在 20%到 80%之间。一些研究表明，与抗心律失常药物 (AAD) 联合使用时反应有所改善。我们对现有文献进行了回顾，以确定右心房消融术、AAD 电复律和起搏相结合的混合治疗在减轻心房颤动负担方面的疗效。所有研究右心房消融术和消融后 AAD 治疗在难治性心房颤动中疗效的人体研究均被考虑在内。主要结局是减少心房颤动负担。次要结局是重大不良事件。我们搜索了 Medline、EMBASE、CINAHL 和 Cochrane 数据库。数据收集、分析和研究选择由两名审查作者独立进行。我们纳入了六项研究，这些研究的参与者数量和结果各不相同。我们将混合治疗的成功定义为心房颤动负担减轻。总共研究了 189 名患者，26%为女性，74%为男性。平均年龄为 58 岁。左心房直径小于 5 厘米，平均射血分数为 64%。平均心房颤动持续时间为 3.35 年。大多数患者至少失败了两种 AAD。混合治疗在 82%的患者中取得了成功。由右心房消融术和 AAD 治疗组成的所有形式的混合治疗似乎都能合理有效地缓解难治性心房颤动的症状，且副作用极小；然而，在任何一种方法的显著优势得到确立之前，还需要进行更大规模的随机试验。
