Zhang Junjie, Sun Haoliang, He Keshuai, Gu Jiaxi, Zheng Rui, Shao Yongfeng
Department of Cardiothoracic Surgery, Changzhou Wujin People's Hospital, Jiangsu.
The First Clinical Medical School of Nanjing Medical University, Nanjing, China.
Medicine (Baltimore). 2019 Jan;98(3):e14053. doi: 10.1097/MD.0000000000014053.
Despite the successful creation of complex lesion sets during hybrid ablation (HA), reoccurrence of atrial fibrillation (AF), and/or atrial arrhythmia and procedural complications still occur. The main objective of this study was to compare the efficacy and safety between HA and transcatheter ablation (TA).
We searched Pubmed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) database up to October 2017. Studies that satisfied our predefined inclusion criteria were included. Of the 894 records, 4 studies encompassing 331 patients were included in our study. We assessed pooled data using random-effect or fixed-effect model. The main endpoint was freedom of atrial arrhythmia after follow-up duration, secondary results were procedure time and intraoperative and postoperative adverse events. Similarly, tertiary outcomes were endocardial time, fluoroscopy time, and postoperative hospitalization.
Compared with TA, HA treatment through mini-thoracotomy access improved superiority in freedom of atrial arrhythmia after follow-up duration (odds ratio [OR] = 6.67, 95% confidence interval [CI]: 2.63-16.90), but HA increased the incidence of intraoperative and postoperative adverse events for AF patients (OR = 2.98, 95% CI: 1.30-6.83). HA through either mini-thoracotomy or transdiaphragmatic/subxiphoid access had longer procedure time and postoperative hospitalization than TA. However, endocardial time was shorter than TA.
For AF patients, HA possessed of an overall superior outcome using mini-thoracotomy way to TA. Although HA had longer procedure time, it yielded a reduction in endocardial time. Meanwhile, we should pay attention to the significantly high risk of intraoperative and postoperative adverse events that the HA generated.
尽管在杂交消融（HA）过程中成功创建了复杂的病变集，但房颤（AF）和/或房性心律失常仍会复发，且手术并发症依然存在。本研究的主要目的是比较HA与经导管消融（TA）之间的疗效和安全性。
我们检索了截至2017年10月的Pubmed、Embase和Cochrane对照试验中心注册库（CENTRAL）数据库。纳入符合我们预先定义的纳入标准的研究。在894条记录中，有4项研究共331例患者被纳入我们的研究。我们使用随机效应或固定效应模型评估汇总数据。主要终点是随访期后房性心律失常的缓解情况，次要结果是手术时间以及术中和术后不良事件。同样，三级结果是心内膜时间、透视时间和术后住院情况。
与TA相比，通过小切口开胸途径进行的HA治疗在随访期后房性心律失常缓解方面具有更高的优势（优势比[OR]=6.67，95%置信区间[CI]：2.63 - 16.90），但HA增加了AF患者术中和术后不良事件的发生率（OR=2.98，95%CI：1.30 - 6.83）。通过小切口开胸或经膈/剑突下入路的HA比TA的手术时间和术后住院时间更长。然而，心内膜时间比TA短。
对于AF患者，采用小切口开胸方式的HA总体疗效优于TA。虽然HA的手术时间更长，但心内膜时间有所缩短。同时，我们应注意HA所产生的术中和术后不良事件的显著高风险。
