National United Engineering Laboratory for Biomedical Material Modification Branden Industrial Park, Dezhou, China.
Tenth People's Hospital of Tongji University, Shanghai, China.
J Cardiovasc Pharmacol. 2019 Apr;73(4):241-247. doi: 10.1097/FJC.0000000000000654.
Radiofrequency ablation (RFA) and antiarrhythmic drugs (AADs) are the main treatments used for atrial fibrillation (AF). In recent years, a number of articles comparing the 2 treatments have begun to emerge. Though, the influence of follow-up time in the meta-analysis was not considered in these articles. However, more recently, large-scale clinical trial articles have included follow-up with the patients up to 5 years after treatment. Therefore, the aim of this study was to assess the impact of variable follow-up times on the recurrence of AF by observing both the short-term and long-term efficacy and safety of catheter ablation and AADs for the treatment of AF.
The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, 9 randomized controlled trials (n = 1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months was compared. Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% confidence interval: 0.32-0.62). Overall, RFA decreased adverse events in the remaining trials; however, AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications.
RFA is more advantageous in terms of recurrence rate of AF than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up; however, these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.
射频消融（RFA）和抗心律失常药物（AAD）是治疗心房颤动（AF）的主要方法。近年来，一些比较这两种治疗方法的文章开始出现。然而，这些文章并没有考虑荟萃分析中随访时间的影响。然而，最近，一些大规模的临床试验文章包括了对治疗后 5 年内患者的随访。因此，本研究旨在通过观察导管消融和 AAD 治疗 AF 的短期和长期疗效和安全性，评估不同随访时间对 AF 复发的影响。
邀请合格的随机对照试验的主要研究者提供标准化的结局数据。对于连续和二分类结局，采用标准化均数差值和比值比及其 95%置信区间作为汇总估计值。本研究共纳入 9 项随机对照试验（n=1542 例患者）。比较了无随访时间限制、随访时间>12 个月、>18 个月、>24 个月、>30 个月和接近 36 个月时 AF 的复发率。此外，还发现 RFA 和 AAD 组 AF 复发率的差异随随访时间的延长而呈反比缩小。当随访时间达到 24 个月时，RFA 和 AAD 之间的差异相对稳定，比值比为 0.45（95%置信区间：0.32-0.62）。总体而言，RFA 在减少残留试验中的不良事件方面更有优势；然而，AAD 在安全性方面表现更好，且 RFA 引起的不良事件通常更严重。
RFA 在 AF 的复发率方面比药物治疗更有优势。此外，分析表明这种效果在长期随访中仍然存在；然而，这些益处似乎随着随访时间的延长而减少。最后，AAD 在安全性方面表现更好，且不良事件更少。
