心房颤动消融术后的腺苷检测：系统评价与荟萃分析
Adenosine Testing After Atrial Fibrillation Ablation: Systematic Review and Meta-Analysis.
作者信息
Wang Nelson, Phan Steven, Kanagaratnam Aran, Kumar Narendra, Phan Kevin
机构信息
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia.
出版信息
Heart Lung Circ. 2018 May;27(5):601-610. doi: 10.1016/j.hlc.2017.04.020. Epub 2017 Jun 7.
BACKGROUND
Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF.
METHODS
Meta-analysis of 22 studies was performed to assess the rates of freedom from AF in 1) patients with dormant PV conduction versus patients without dormant PV conduction, and 2) patients given routine adenosine post PVI versus patients not given adenosine. Relative-risks (RR) were calculated using random effects modelling.
RESULTS
In 18 studies, 3038 patients received adenosine and freedom from AF in those patients with dormant PV reconnection was significantly lower (62.9%) compared to patients without PV reconnection (67.2%) (RR 0.87; 95% CI: 0.78-0.98). In seven studies with 3049 patients, the freedom from AF was significantly higher in patients who received adenosine (67%) versus those patients who did not receive adenosine (63%) (RR: 1.11; 95% CI: 1.01-1.22).
CONCLUSIONS
The present study showed clear benefits of adenosine testing for freedom from AF recurrence. Adenosine-guided dormant conduction is associated with higher AF recurrence despite further ablation. Future studies should investigate the optimal methodology, including dosage and waiting time between PVI and adenosine administration.
背景
腺苷可用于揭示肺静脉隔离（PVI）治疗心房颤动（AF）后隐匿性肺静脉（PV）传导情况。我们进行了一项系统评价和荟萃分析，以评估腺苷给药对接受AF-PVI患者的影响。
方法
对22项研究进行荟萃分析，以评估1）隐匿性PV传导患者与无隐匿性PV传导患者的AF复发率，以及2）PVI后接受常规腺苷治疗的患者与未接受腺苷治疗的患者的AF复发率。采用随机效应模型计算相对风险（RR）。
结果
在18项研究中，3038例患者接受了腺苷治疗，隐匿性PV重新连接患者的AF复发率（62.9%）显著低于无PV重新连接患者（67.2%）（RR 0.87；95%CI：0.78-0.98）。在7项共3049例患者的研究中，接受腺苷治疗的患者AF复发率（67%）显著高于未接受腺苷治疗的患者（63%）（RR：1.11；95%CI：1.01-1.22）。
结论
本研究表明腺苷检测对预防AF复发有明显益处。尽管进行了进一步消融，腺苷引导的隐匿性传导仍与较高的AF复发率相关。未来的研究应探讨最佳方法，包括剂量以及PVI与腺苷给药之间的等待时间。
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