Afzal Muhammad R, Samanta Anweshan, Chatta Jawaria, Ansari Brihh, Atherton Sam, Sabzwari Syed, Turagam Mohit, Lakkireddy Dhanunjaya, Houmsse Mahmoud
a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital , The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA.
b Division of Cardiovascular Medicine , University of Kansas Medical Center , Kansas City , KS , USA.
Expert Rev Cardiovasc Ther. 2017 Mar;15(3):227-235. doi: 10.1080/14779072.2017.1294064. Epub 2017 Mar 1.
Pulmonary vein (PV) isolation (PVI) has suboptimal outcomes in patients with non-paroxysmal atrial fibrillation (AF). Adjunctive strategies employed to ablate non-PV triggers have shown favorable outcomes.
To delineate the incremental benefit of adjunctive ablation in patients with non-paroxysmal AF through a meta-analysis.
Database searches through August 2016 identified five non-randomized and seven randomized controlled trials (enrolling 1694 patients). The adjunctive strategies employed for non-PV ablation included focal impulse and rotor modulation; empirical linear lines, ablation of complex fractionated atrial electrograms and ganglionated plexi. The risk ratio (RR) for AF recurrence, calculated with random effects meta-analysis showed a 36% reduction of AF recurrence at a median follow up of 12 months (RR: 0.64, 95% Confidence interval: 0.48 to 0.85; p = 0.003). The benefits persisted during longer follow up when assessed in subgroup analysis.
Addition of adjunctive ablation to PVI improves outcomes.
在非阵发性心房颤动（AF）患者中，肺静脉（PV）隔离（PVI）的效果并不理想。用于消融非肺静脉触发灶的辅助策略已显示出良好的效果。
通过荟萃分析来阐明辅助消融在非阵发性房颤患者中的额外获益。
截至2016年8月的数据库检索确定了5项非随机试验和7项随机对照试验（纳入1694例患者）。用于非肺静脉消融的辅助策略包括局灶冲动与转子调制；经验性线性消融线、碎裂心房电图消融和神经节丛消融。采用随机效应荟萃分析计算的房颤复发风险比（RR）显示，在中位随访12个月时，房颤复发减少36%（RR：0.64，95%置信区间：0.48至0.85；p = 0.003）。在亚组分析中评估时，这些益处持续存在于更长时间的随访中。
在PVI基础上加用辅助消融可改善治疗效果。
