Koerber Scott M, Turagam Mohit K, Gautam Sandeep, Winterfield Jeffrey, Wharton J Marcus, Lakkireddy Dhanunjaya, Gold Michael R
Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
Division of Cardiology, Mount Sinai School of Medicine, New York City, New York.
Pacing Clin Electrophysiol. 2019 May;42(5):493-498. doi: 10.1111/pace.13637. Epub 2019 Mar 18.
Atrial arrhythmias (AA), including atrial fibrillation (AF), have been reported in patients after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL). Several studies have examined the effect of performing concomitant pulmonary vein isolation (PVI) with CTI on recurrent AA. These studies were analyzed to determine the overall effect of this approach on recurrent AA.
PubMed and Google Scholar were searched for randomized trials comparing the incidence of AA after CTI versus CTI + PVI until June 2018. Only patients without prior history of AF were included in the recurrent AA analysis. All patients were included in the analyses of other clinical outcomes.
Four randomized control trials were included in the meta-analysis. In the recurrent AA analysis, a total of 314 patients were randomized in the studies (n = 158 CTI, n = 156 CTI + PVI). Freedom from AA at 1 year was significantly higher in the CTI + PVI group versus CTI alone (odds ratio [OR] 0.25 [0.14, 0.44] 95% confidence interval [CI], P < 0.00001). A total of 550 patients (n = 336 CTI, n = 214 CTI + PVI) were included in analyses for procedure time, fluoroscopy time, and complications rates. Procedure time and fluoroscopy time were significantly longer in the CTI + PVI group (mean difference [MD]: 103.31 min [94.40, 112.23] 95% CI, P < 0.00001) and (MD: 16.47 min [14.89, 18.05] 95% CI, P < 0.00001), respectively. Total complications were statistically similar between groups.
This meta-analysis shows addition of a prophylactic PVI during CTI ablation significantly reduces recurrent AA at 1 year without significantly increasing major complications.
在典型心房扑动（AFL）患者行三尖瓣峡部（CTI）消融术后，已报告出现包括心房颤动（AF）在内的房性心律失常（AA）。多项研究探讨了CTI消融时同期行肺静脉隔离（PVI）对AA复发的影响。对这些研究进行分析以确定该方法对AA复发的总体影响。
检索PubMed和谷歌学术，查找比较CTI消融与CTI + PVI消融术后AA发生率的随机试验，检索截至2018年6月。复发AA分析仅纳入无AF既往史的患者。所有患者均纳入其他临床结局分析。
荟萃分析纳入4项随机对照试验。在复发AA分析中，研究共纳入314例随机分组患者（n = 158例CTI组，n = 156例CTI + PVI组）。CTI + PVI组1年无AA发生率显著高于单纯CTI组（优势比[OR] 0.25 [0.14, 0.44]，95%置信区间[CI]，P < 0.00001）。共550例患者（n = 336例CTI组，n = 214例CTI + PVI组）纳入手术时间、透视时间和并发症发生率分析。CTI + PVI组手术时间和透视时间显著更长（平均差[MD]：103.31分钟[94.40, 112.23]，95% CI，P < 0.00001）和（MD：16.47分钟[14.89, 18.05]，95% CI，P < 0.00001）。两组总并发症在统计学上相似。
该荟萃分析表明，CTI消融时加用预防性PVI可显著降低1年时AA复发率，且未显著增加主要并发症。
