Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Department of Heart and Vessels, Ospedale di Circolo & Macchi Foundation, University of Insubria, Varese, Italy.
J Cardiovasc Electrophysiol. 2020 May;31(5):1040-1047. doi: 10.1111/jce.14429. Epub 2020 Mar 9.
The impact of atrial fibrillation catheter ablation (AFCA) on hard clinical endpoints remains controversial.
Our aim was to conduct a random-effect model meta-analysis on efficacy data from high-quality large matched database/registry studies and randomized clinical trials. We compared long-term all-cause mortality, stroke, and hospitalization for heart failure in patients undergoing AFCA vs patients treated with medical therapy alone (rhythm and/or rate control medications) in a general AF population.
PubMed/MEDLINE and Embase databases were screened and a total of nine studies were selected (one randomized clinical trial-CABANA-and eight large matched population studies). A total of 241 372 patients (27 711 in the ablation group, 213 661 in the nonablation group) were included. After a median follow-up of 3.5 years, AFCA decreased the risk of mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54-0.72; I = 54%; number needed to treat [NNT] = 28), stroke (HR, 0.63; 95% CI, 0.56-0.70; I = 23%; NNT = 59) and hospitalization for heart failure (HR, 0.64; 95% CI, 0.51-0.80; I = 28%; NNT = 33) compared with AF patients treated with medical therapy alone.
Based on the currently available efficacy and effectiveness evidence, AFCA significantly reduces the risk of death, stroke, and hospitalization compared with medical therapy alone.
心房颤动导管消融（AFCA）对硬性临床终点的影响仍存在争议。
我们旨在对高质量大匹配数据库/注册研究和随机临床试验的疗效数据进行随机效应模型荟萃分析。我们比较了在一般房颤人群中，接受 AFCA 治疗的患者与仅接受药物治疗（节律和/或心率控制药物）的患者的长期全因死亡率、卒中和心力衰竭住院率。
我们筛选了 PubMed/MEDLINE 和 Embase 数据库，共选择了 9 项研究（1 项随机临床试验-CABANA 和 8 项大型匹配人群研究）。共纳入 241372 例患者（消融组 27711 例，非消融组 213661 例）。中位随访 3.5 年后，AFCA 降低了死亡率（风险比 [HR]，0.62；95%置信区间 [CI]，0.54-0.72；I = 54%；需要治疗的人数 [NNT] = 28）、卒中和心力衰竭住院的风险（HR，0.63；95%CI，0.56-0.70；I = 23%；NNT = 59）与单独接受药物治疗的房颤患者相比。
基于目前可用的疗效和有效性证据，AFCA 与单独药物治疗相比，显著降低了死亡、卒中和心力衰竭的风险。
