Xie Xinxing, Liu Xujie, Chen Bo, Wang Qing
Deparment of Cardiology, Rizhao Heart Hospital, Rizhao, Shandong, China (mainland).
Department of Cardiology, The Third Hospital of Jinan, Jinan, Shandong, China (mainland).
Med Sci Monit Basic Res. 2018 Jun 30;24:96-102. doi: 10.12659/MSMBR.910338.
BACKGROUND New-onset atrial fibrillation (AF) is common after atrial flutter (AFL) ablation, but it was unclear whether AF ablation could reduce the incidence of AF in AFL patients without AF history. The present meta-analysis was conducted to evaluate the benefit of prophylactic AF ablation in reducing the occurrence of AF in typical AFL patients. MATERIAL AND METHODS We systematically searched PubMed, EMBASE, and the Cochrane Library from inception to December 2017 for randomized controlled trials (RCTs) that assessed the efficacy of AF ablation in reducing the occurrence of AF in AFL patients without AF. Trial sequential analysis (TSA) was used to control random errors and calculate the required information size. RESULTS Four trials (n=357 patients) met the inclusion criteria and were included in our meta-analysis. The incidence of AF after AFL ablation was 46.4%. We observed that prophylactic AF ablation reduced the AF incidence compared with simple AFL ablation (26.1% versus 46.4%, RR: 0.57, 95% CIs: 0.42-0.76, P=0.0002) with a prolonged procedure duration (P<0.00001) and fluoroscopy time (P=0.004). Further TSA indicated that more RCTs were needed to reach more conclusive results. There was no significant difference in clinical complications (P=0.33) between the 2 groups. CONCLUSIONS This meta-analysis provides evidence that prophylactic AF ablation may be more effective than simple AFL ablation in reducing AF incidence after AFL ablation. Large prospective RCTs are warranted to confirm the benefit of prophylactic AF ablation in AFL patients without AF history.
新发房颤（AF）在心房扑动（AFL）消融术后很常见，但尚不清楚房颤消融能否降低无房颤病史的AFL患者发生房颤的发生率。本荟萃分析旨在评估预防性房颤消融在降低典型AFL患者房颤发生率方面的益处。
我们系统检索了从数据库建立至2017年12月的PubMed、EMBASE和Cochrane图书馆，以查找评估房颤消融在降低无房颤的AFL患者房颤发生率方面疗效的随机对照试验（RCT）。采用试验序贯分析（TSA）控制随机误差并计算所需信息量。
四项试验（n = 357例患者）符合纳入标准并纳入我们的荟萃分析。AFL消融术后房颤的发生率为46.4%。我们观察到，与单纯AFL消融相比，预防性房颤消融降低了房颤发生率（26.1%对46.4%，RR：0.57，95%CI：0.42 - 0.76，P = 0.0002），但手术时间延长（P < 0.00001），透视时间延长（P = 0.004）。进一步的TSA表明需要更多的RCT才能得出更确凿的结果。两组临床并发症无显著差异（P = 0.33）。
本荟萃分析提供的证据表明，预防性房颤消融在降低AFL消融术后房颤发生率方面可能比单纯AFL消融更有效。需要大型前瞻性RCT来证实预防性房颤消融对无房颤病史的AFL患者的益处。
