Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK; Division of Clinical Electrophysiology, Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
Int J Cardiol. 2018 Sep 1;266:136-142. doi: 10.1016/j.ijcard.2018.03.068.
Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and stroke is still debated.
To determine whether AF ablation is associated with a reduction in all-cause mortality and stroke compared with medical therapy alone.
Literature search looking for both randomized and observational studies comparing AF catheter ablation vs. medical management. Data pooled using random-effects. Risk ratios (RR) with 95% confidence intervals (CI) used as a measure of treatment effect. The primary and secondary outcomes were all-cause mortality and occurrence of cerebrovascular events during follow-up, respectively.
Thirty studies were eligible for inclusion, comprising 78,966 patients (25,129 receiving AF ablation and 53,837 on medical treatment) and 233,990patient-years of follow-up. The pooled data of studies revealed that ablation was associated with lower risk of all-cause mortality: 5.7% vs. 17.9%; RR=0.44, 95% CI 0.32-0.62, p<0.001. In a sensitivity analysis by study design, a survival benefit of AF ablation was seen in randomized studies, with no heterogeneity (mortality risk 4.2% vs. 8.9%; RR=0.55, 95% CI 0.39-0.79, p=0.001, I=0%), and also in observational studies, but with marked heterogeneity (6.1% vs. 18.3%; RR=0.39, 95% CI 0.26-0.59, p<0.001, I=95%). The mortality benefit in randomized studies was mainly driven by trials performed in patients with left ventricular (LV) dysfunction and heart failure. The pooled risk of a cerebrovascular event was lower in patients receiving AF ablation (2.3% vs. 5.5%; RR=0.57, 95% CI 0.46-0.70, p<0.001, I=62%), but no difference was seen in randomized trials (2.2% vs. 2.1%; RR=0.94, 95% CI 0.46-1.94, p=0.87, I=0%).
Ablation of atrial fibrillation associates with a survival benefit compared with medical treatment alone, although evidence is restricted to the setting of heart failure and LV systolic dysfunction.
维持窦性心律与死亡率降低有关，但房颤（AF）消融本身是否有益于死亡率和卒中等硬终点仍存在争议。
确定与单独药物治疗相比，AF 消融是否与降低全因死亡率和卒中风险相关。
搜索比较 AF 导管消融与药物管理的随机和观察性研究。使用随机效应进行数据汇总。风险比（RR）及其 95%置信区间（CI）用作治疗效果的衡量指标。主要和次要结局分别为随访期间的全因死亡率和脑血管事件的发生。
30 项研究符合纳入标准，共纳入 78966 例患者（25129 例接受 AF 消融，53837 例接受药物治疗）和 233990 例患者年的随访。研究的汇总数据显示，消融与全因死亡率降低相关：5.7%比 17.9%；RR=0.44，95%CI 0.32-0.62，p<0.001。按研究设计进行敏感性分析，随机研究显示 AF 消融具有生存获益，且无异质性（死亡率风险 4.2%比 8.9%；RR=0.55，95%CI 0.39-0.79，p=0.001，I=0%），观察性研究也显示具有生存获益，但异质性显著（6.1%比 18.3%；RR=0.39，95%CI 0.26-0.59，p<0.001，I=95%）。随机研究中死亡率获益主要归因于左心室（LV）功能障碍和心力衰竭患者的试验。接受 AF 消融的患者发生脑血管事件的风险较低（2.3%比 5.5%；RR=0.57，95%CI 0.46-0.70，p<0.001，I=62%），但随机试验中无差异（2.2%比 2.1%；RR=0.94，95%CI 0.46-1.94，p=0.87，I=0%）。
与单独药物治疗相比，房颤消融可带来生存获益，尽管证据仅限于心力衰竭和左心室收缩功能障碍患者。
