Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Xueyuanxi Road, No. 109, Wenzhou, 325000, Zhejiang, China.
Heart Fail Rev. 2019 May;24(3):335-342. doi: 10.1007/s10741-018-9761-5.
Cardiac resynchronization therapy (CRT) has been established to improve prognosis for patients with heart failure and SR. Whether the benefit observed with CRT on survival was similar in AF patients receiving atrio-ventricular junction ablation (AVJA) or not and patients in SR remains uncertain. The primary purpose of this study was to comprehensively evaluate the impact of CRT on the outcome of survival in atrial fibrillation (AF) patients with or without AVJA and patients in sinus rhythm (SR). Medline, Embase, and the Cochrane Library were searched for inception through June 31, 2018. Two reviewers independently evaluated and extracted data from 4 studies, including a total of 7896 CRT recipients, composed of 554 AF with AVJA (CRT+AF+AVJA), 1071 AF without AVJA (CRT+AF-AVJA), and 6244 SR (CRT+SR). The benefit on survival was comparable between CRT+AF+AVJA and CRT+SR (HR = 1.00; 95% CI, 0.73-1.40). CRT+AF+AVJA and CRT+SR both were associated with significantly higher survival compared with CRT+AF-AVJA, with hazard ratio of 0.64 (95% CI, 0.46-0.91) and 0.63 (95% CI, 0.53-0.75), respectively. The survival benefit was similar for patients with CRT+AF+AVJA and CRT+SR, while it was 36-37% high as compared to CRT+AF-AVJA. Whether aggressive intervention with AVJA in AF should be routinely combined with CRT despite rate-slowing drug treatment is helpful deserves further studies.
心脏再同步治疗（CRT）已被确立为改善心力衰竭和窦性节律（SR）患者的预后。在接受房室结消融（AVJA）的心房颤动（AF）患者或窦性节律（SR）患者中，CRT 是否对生存获益的影响尚不确定。本研究的主要目的是全面评估 CRT 对伴有或不伴有 AVJA 的 AF 患者和 SR 患者生存结局的影响。通过 2018 年 6 月 31 日，对 Medline、Embase 和 Cochrane 图书馆进行了检索。两名审查员独立评估并从 4 项研究中提取数据，共纳入 7896 例 CRT 接受者，包括 554 例伴有 AVJA 的 AF（CRT+AF+AVJA）、1071 例不伴有 AVJA 的 AF（CRT+AF-AVJA）和 6244 例 SR（CRT+SR）。CRT+AF+AVJA 与 CRT+SR 之间的生存获益相当（HR=1.00；95%CI，0.73-1.40）。与 CRT+AF-AVJA 相比，CRT+AF+AVJA 和 CRT+SR 均与生存率显著提高相关，风险比分别为 0.64（95%CI，0.46-0.91）和 0.63（95%CI，0.53-0.75）。CRT+AF+AVJA 和 CRT+SR 的生存获益相似，而与 CRT+AF-AVJA 相比，生存获益高 36-37%。尽管存在药物减慢心率的作用，但在 AF 中常规联合 AVJA 进行积极干预是否应与 CRT 联合使用，值得进一步研究。
