Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia (A.T., K. Kadhim, D.H.L., M.E., D.L., K. Khokhar, D.A.M., R.M., V.M., C.O., R.M., P.S.).
Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia (A.T., K. Kadhim, D.H.L., M.E., D.L., K. Khokhar, D.A.M., V.M., C.O., R.M., P.S.).
Circ Arrhythm Electrophysiol. 2019 Aug;12(8):e007005. doi: 10.1161/CIRCEP.118.007005. Epub 2019 Aug 12.
The posterior left atrium is an arrhythmogenic substrate that contributes to the initiation and maintenance of atrial fibrillation (AF); however, the feasibility, safety, and efficacy of posterior wall isolation (PWI) as an AF ablation strategy has not been widely reported.
We undertook a systematic review and meta-analysis of studies performing PWI to assess (1) acute procedural success including the ability to achieve PWI and the number of procedure-related complications, (2) Long-term, clinical success including rates of arrhythmia recurrence and posterior wall reconnection, and (3) The efficacy of PWI compared with pulmonary vein isolation on preventing arrhythmia recurrence. MEDLINE, EMBASE, and Web of Science databases were searched in May 2018 to retrieve relevant studies. Results were pooled using a random effects model.
Seventeen studies (13 box isolation, 3 single ring isolation, and 1 debulking ablation) comprising 1643 patients (31.3% paroxysmal AF, left atrial diameter 41±3.1 mm) were included in the final analysis. In studies focusing specifically on PWI, the acute procedural success rate for achieving PWI was 94.1% (95% CI, 87.2%-99.3%). Single-procedure 12-month freedom from atrial arrhythmia was 65.3% (95% CI, 57.7%-73.9%) overall and 61.9% (54.2%-70.8%) for persistent AF. Randomized control trials comparing PWI to pulmonary vein isolation (3 studies, 444 patients) yielded conflicting results and could not confirm an incremental benefit to PWI. Fifteen major complications (0.1%), including 2 atrio-esophageal fistulas, were reported.
PWI as an end point of AF ablation can be achieved in a large proportion of cases with good rates of 12-month freedom from atrial arrhythmia. Although the procedure-related complication rate is low, it did not eliminate the risk of atrio-esophageal fistula. Registration: URL: http://www.crd.york.ac.uk/prospero. PROSPERO registration number: CRD42018107212.
左心房后壁是致心律失常的基质，有助于房性颤动（AF）的起始和维持；然而，后壁隔离（PWI）作为 AF 消融策略的可行性、安全性和疗效尚未得到广泛报道。
我们对行 PWI 的研究进行了系统回顾和荟萃分析，以评估（1）急性程序成功率，包括实现 PWI 的能力和与程序相关的并发症数量，（2）长期临床成功率，包括心律失常复发率和后壁再连接率，以及（3）PWI 与肺静脉隔离预防心律失常复发的疗效。2018 年 5 月，检索 MEDLINE、EMBASE 和 Web of Science 数据库以检索相关研究。使用随机效应模型汇总结果。
最终分析纳入了 17 项研究（13 项盒式隔离，3 项单环隔离和 1 项消蚀消融），共 1643 例患者（31.3%阵发性 AF，左心房直径 41±3.1mm）。在专门关注 PWI 的研究中，实现 PWI 的急性程序成功率为 94.1%（95%CI，87.2%-99.3%）。总的 12 个月无房性心律失常率为 65.3%（95%CI，57.7%-73.9%），持续性 AF 为 61.9%（54.2%-70.8%）。比较 PWI 与肺静脉隔离的随机对照试验（3 项研究，444 例患者）得出了相互矛盾的结果，无法证实 PWI 有额外获益。报告了 15 例重大并发症（0.1%），包括 2 例食-房瘘。
作为 AF 消融的终点，PWI 可以在很大比例的病例中实现，并且 12 个月无房性心律失常的成功率较高。尽管程序相关并发症的发生率较低，但并不能消除食-房瘘的风险。注册：网址：http://www.crd.york.ac.uk/prospero.CRD42018107212 号 PROSPERO 注册。
