Stern Joshua D, Rolnitzky Linda, Goldberg Judith D, Chinitz Larry A, Holmes Douglas S, Bernstein Neil E, Bernstein Scott A, Khairy Paul, Aizer Anthony
Leon H. Charney Heart Rhythm Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York 10016, USA.
Pacing Clin Electrophysiol. 2011 Mar;34(3):269-77. doi: 10.1111/j.1540-8159.2010.02948.x. Epub 2010 Nov 11.
There are little data on the appropriate endpoint for slow pathway ablation that balances acceptable procedural times, recurrence rates, and complication rates. This study compared recurrence rates of three commonly utilized endpoints of slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT).
We performed a meta-analysis of AVNRT slow pathway ablation cohorts by searching electronic databases, the Internet, and conference proceedings. Inclusion criteria were age >18 years, >20 human subjects per study, primary AVNRT ablation, English language publication, and >1 month of follow-up. Data were analyzed with a fixed-effects model using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA).
We included 10 studies encompassing 1,204 patients with a mean age of 41-53 years. Endpoints were complete slow pathway ablation, residual jump only, and single remaining echo beat. Pooled estimates revealed 28 of 641 patients (4.4%) with complete slow pathway ablation, 13 of 192 patients (6.8%) with a residual jump only, and 24 of 371 patients (6.5%) with one echo had recurrences. With uniform isoproterenol use after ablation, there was no significant difference in recurrence rates among the endpoints. However, when isoproterenol was utilized after ablation only if needed to induce AVNRT before ablation, a significantly higher recurrence rate occurred in patients with a residual jump (P = 0.002), a single echo (P = 0.003), or the combined group of a residual jump and/or one echo (P = 0.001).
Isoproterenol should be used routinely after slow pathway modification, when a residual jump and/or single echo remain.
关于房室结折返性心动过速（AVNRT）慢径路消融的合适终点，能平衡可接受的手术时间、复发率和并发症发生率的数据很少。本研究比较了AVNRT慢径路消融三个常用终点的复发率。
我们通过检索电子数据库、互联网和会议记录，对AVNRT慢径路消融队列进行了荟萃分析。纳入标准为年龄>18岁、每项研究>20名受试者、首次进行AVNRT消融、英文发表以及随访>1个月。使用综合荟萃分析软件2.2.046（美国新泽西州恩格尔伍德的Biostat公司）的固定效应模型对数据进行分析。
我们纳入了10项研究，共1204例患者，平均年龄41 - 53岁。终点为完全慢径路消融、仅残留跳跃和单个剩余回波搏动。汇总估计显示，641例完全慢径路消融患者中有28例（4.4%）复发，192例仅残留跳跃患者中有13例（6.8%）复发，371例有一个回波的患者中有24例（6.5%）复发。消融后统一使用异丙肾上腺素，各终点之间的复发率无显著差异。然而，当仅在消融前需要诱发AVNRT时才在消融后使用异丙肾上腺素时，残留跳跃患者（P = 0.002）、单个回波患者（P = 0.003）或残留跳跃和/或一个回波的联合组患者（P = 0.001）的复发率显著更高。
当残留跳跃和/或单个回波仍然存在时，慢径路改良后应常规使用异丙肾上腺素。
