Division of Cardiology, Department of Medical Sciences, Città della salute e della scienza, University of Turin, Turin, Italy.
Division of Cardiology, Department of Medical Sciences, Città della salute e della scienza, University of Turin, Turin, Italy.
Int J Cardiol. 2018 Nov 1;270:172-179. doi: 10.1016/j.ijcard.2018.06.082. Epub 2018 Jun 19.
Anticoagulantion therapy (OAT) represents the cornerstone to reduce thromboembolic events for atrial fibrillation (AF). Recent studies suggest that AF catheter ablation on top of OAT may be useful to further reduce the thromboembolic risk in AF patients. The aim of the present study is to compare the long-term risk of thromboembolic events and treatment-related complications in patients with AF treated by OAT strategies and catheter ablation.
Pubmed, Cochrane and Google Scholar were searched for studies including >500 patients evaluating AF patients treated with OAT (VKA: vitamin K antagonist or DOAC: Direct oral anticoagulants) and/or AF ablation. Pooled incidence of stroke/year was the primary end point, while that of stroke, of all cause bleeding and of major bleeding the secondary ones. All the analyses were stratified according to the CHADS score of included patients.
Overall, 27 studies were selected, including 50,973 patients in the AF catheter ablation group; 281,595 patients in the VKA group; 54,811 patients in the DOAC group. After a mean follow-up of 2.4 (1.5-3.8) years, the overall incidence of stroke and thromboembolic events was 0.63 per 100 patients/year in AF ablation group, 2.09 per 100 patients/year in VKA group and 1.24 per 100 patients/year in DOAC group (p < 0.001). After stratification in 4 groups according to CHADS score, the incidence of thromboembolic events remained lower in patients included in the AF ablation, followed by DOAC and VKA respectively (p < 0.001), for each CHADS cluster. Both the incidence of all cause bleedings and major bleedings resulted lower in AF ablation group (p < 0.001). The incidence of all-cause mortality in the AF ablation group was significant lower than in the group of OAT (p < 0.0001).
AF catheter ablation significantly reduces the incidence of long-term thromboembolic events compared to both VKA and DOAC. This reduction is maintained in all CHADS score clusters and is strengthened by the concomitant reduction in hemorrhagic complications provided by AF ablation.
抗凝治疗（OAT）是减少心房颤动（AF）血栓栓塞事件的基石。最近的研究表明，在 OAT 基础上进行 AF 导管消融可能有助于进一步降低 AF 患者的血栓栓塞风险。本研究旨在比较 OAT 策略和导管消融治疗的 AF 患者的长期血栓栓塞事件和治疗相关并发症风险。
在 PubMed、Cochrane 和 Google Scholar 上搜索了超过 500 例评估接受 OAT（维生素 K 拮抗剂或 DOAC：直接口服抗凝剂）和/或 AF 消融治疗的 AF 患者的研究。卒中/年的发生率为主要终点，卒中、所有原因出血和大出血的发生率为次要终点。所有分析均根据纳入患者的 CHADS 评分进行分层。
共纳入 27 项研究，其中 AF 导管消融组 50973 例患者，VKA 组 281595 例患者，DOAC 组 54811 例患者。平均随访 2.4（1.5-3.8）年后，AF 消融组的总体卒中及血栓栓塞事件发生率为 0.63/100 患者/年，VKA 组为 2.09/100 患者/年，DOAC 组为 1.24/100 患者/年（p<0.001）。根据 CHADS 评分将患者分为 4 组后分层，AF 消融组的血栓栓塞事件发生率较低，其次是 DOAC 组和 VKA 组（p<0.001），每个 CHADS 亚组均如此。AF 消融组的所有原因出血和大出血发生率均较低（p<0.001）。AF 消融组的全因死亡率明显低于 OAT 组（p<0.0001）。
与 VKA 和 DOAC 相比，AF 导管消融可显著降低长期血栓栓塞事件的发生率。这种降低在所有 CHADS 评分亚组中均得到维持，并且由于 AF 消融带来的出血并发症减少而得到加强。
