Department of Cardiology, The First Affiliated Hospital, Sun Yet-sen University, Guangzhou, China.
Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Clin Cardiol. 2020 Jun;43(6):594-605. doi: 10.1002/clc.23354. Epub 2020 Mar 11.
Atrial fibrillation (AF) is an important risk factor for thromboembolic events, for which catheter ablation represents an effective therapy for rhythm control. Intuitively, ablation may reduce the incidence of thromboembolism, but data is quite limited.
Catheter ablation was associated with the fewer risk of thromboembolism compared with nonablation in patients with AF.
A systematic search was performed in PubMed, EMBASE, the Web of Science, and the Cochrane Library from inception to September 2019. Random-effects model was used to estimate the risk ratios (RR) for the thromboembolic events between the ablation and nonablation groups.
Twenty-five studies (12 randomized controlled trials and 13 observational studies) with 104 687 participants were included. Pooled analysis suggested that ablation was associated with a 35% lower risk of total thromboembolic events compared to nonablation group (RR = 0.65; 95% CI, 0.51-0.82; P = .0003). When separated into early-phase (<30 days) and late-phase (>30 days) events, ablation was associated with an increased early-phase thromboembolism (RR = 1.96; 95% CI, 1.35-2.83; P = .0004) but a decreased late-phase thromboembolism (RR = 0.75; 95% CI, 0.63-0.90; P = .002). Subgroup analysis according to different study types found similar results were found in observation studies, but not in RCT studies because the sample size was too small to be conclusive.
In patients with AF, catheter ablation was associated with a fewer risk of overall and late-phase thromboembolism in comparison with nonablation. However, over the early postoperative period, catheter ablation was associated with the double higher risk of thromboembolic events.
心房颤动（AF）是血栓栓塞事件的重要危险因素，导管消融术是节律控制的有效治疗方法。直觉上，消融术可能会降低血栓栓塞的发生率，但数据非常有限。
与非消融组相比，AF 患者的导管消融术与血栓栓塞风险降低相关。
从开始到 2019 年 9 月，在 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆进行了系统检索。使用随机效应模型估计消融组和非消融组之间血栓栓塞事件的风险比（RR）。
共纳入 25 项研究（12 项随机对照试验和 13 项观察性研究），共 104687 名参与者。荟萃分析表明，与非消融组相比，消融组总血栓栓塞事件的风险降低了 35%（RR=0.65；95%CI，0.51-0.82；P=0.0003）。当分为早期（<30 天）和晚期（>30 天）事件时，消融组与早期血栓栓塞增加相关（RR=1.96；95%CI，1.35-2.83；P=0.0004），但晚期血栓栓塞减少（RR=0.75；95%CI，0.63-0.90；P=0.002）。根据不同研究类型进行的亚组分析发现，观察性研究中也有类似的结果，但在 RCT 研究中则没有，因为样本量太小，无法得出结论。
在 AF 患者中，与非消融相比，导管消融与整体和晚期血栓栓塞风险降低相关。然而，在术后早期，导管消融与血栓栓塞事件的风险增加两倍相关。
