Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd, WP 3010, Oklahoma City, OK 73104, USA.
Europace. 2012 Oct;14(10):1490-7. doi: 10.1093/europace/eus193. Epub 2012 Jun 13.
Atrioventricular junction (AVJ) ablation with permanent pacing improves symptoms in selected patients with atrial fibrillation (AF). The optimal pacing modality after AVJ ablation remains unclear. We performed a meta-analysis of randomized controlled trials to examine whether cardiac resynchronization therapy (CRT) is superior to right ventricular (RV) pacing in this patient population.
We searched the MEDLINE and EMBASE databases for studies evaluating the effect of CRT vs. RV pacing after AVJ ablation for AF. Pooled risk ratios (RRs) and mean differences with 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively, using a random effects model. Five trials involving 686 patients (413 in CRT and 273 in RV pacing group) were included in the analysis. On the basis of the pooled estimate across the studies, CRT resulted in a non-significant reduction in mortality (RR = 0.75, 95% CI 0.43-1.30; P= 0.30) and a significant reduction in hospitalizations for heart failure (RR = 0.38, 95% CI = 0.17-0.85; P= 0.02) compared with RV pacing. Cardiac resynchronization therapy did not improve 6 min walk distance (mean difference 15.7, 95% CI -7.2 to 38.5 m; P= 0.18) and Minnesota Living with Heart Failure quality-of-life score (mean difference -3.0, 95% CI -8.6 to 2.6; P= 0.30) compared with RV pacing. The change in left ventricular ejection fraction between baseline and 6 months favoured CRT (mean change 2.0%, 95% CI 1.5-2.4%; P< 0.001).
Cardiac resynchronization therapy may be superior to RV pacing in patients undergoing AVJ ablation for AF. Further studies, adequately powered to detect clinical outcomes, are required.
房室结（AVJ）消融联合永久性起搏可改善特定心房颤动（AF）患者的症状。AVJ 消融后最佳起搏模式仍不明确。我们进行了一项荟萃分析，旨在评估心脏再同步治疗（CRT）是否优于右心室（RV）起搏在该患者人群中的效果。
我们检索了 MEDLINE 和 EMBASE 数据库，以评估 AVJ 消融治疗 AF 后 CRT 与 RV 起搏的效果。采用随机效应模型分别对分类和连续结局计算汇总风险比（RR）和均数差值及其 95%置信区间（CI）。共有 5 项涉及 686 例患者（CRT 组 413 例，RV 起搏组 273 例）的研究纳入分析。根据研究的汇总估计值，与 RV 起搏相比，CRT 可降低死亡率（RR = 0.75，95%CI 0.43-1.30；P=0.30），显著降低心力衰竭住院率（RR = 0.38，95%CI 0.17-0.85；P=0.02）。与 RV 起搏相比，CRT 并未改善 6 分钟步行距离（平均差值 15.7，95%CI -7.2 至 38.5 m；P=0.18）和明尼苏达州心力衰竭生活质量评分（平均差值 -3.0，95%CI -8.6 至 2.6；P=0.30）。与基线相比，6 个月时左心室射血分数的变化更有利于 CRT（平均变化 2.0%，95%CI 1.5-2.4%；P<0.001）。
在 AVJ 消融治疗 AF 的患者中，CRT 可能优于 RV 起搏。需要进一步研究，以确定 CRT 是否可以改善临床结局。
