Torbey Estelle, Karam Boutros, Sleiman Elsa, Tabet Rabih, Kirk Malcolm, Donaldson David, Chu Antony D
Electrophysiology, Rhode Island University Hospital - Warren Alpert Medical School of Brown University, Rhode Island, USA.
Cardiology, Staten Island University Hospital - Northwell Health, Staten Island, USA.
Cureus. 2020 Apr 25;12(4):e7824. doi: 10.7759/cureus.7824.
Introduction Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are frequently associated with atrial fibrillation (AF). Targeting the slow or accessory pathways has been advocated as therapy for coexisting AF. But in practice, AF has frequently recurred after ablation, possibly because of various risk factors. The objective of this study is to investigate these risk factors and check for their significance in AF recurrence. Materials and methods A systematic review of Medline, Cochrane, and ClinicalTrials.gov databases was conducted. Articles that studied AF recurrence after either AVNRT or AVRT ablation were reviewed. Publication bias was adequately assessed, and the random method was applied for all dichotomous values. Finally, the odds ratio (OR) and confidence intervals (CI) were calculated for each risk factor. Results Four studies were included, with a total of 1,308 participants. Only 218 participants had dual tachycardia (AF with either AVNRT or AVRT). The mean follow-up time was 29 +/- 3.3 months. The mean age was 56 +/- 15 years. Age constituted the only significant risk factor for AF recurrence (OR: 3.4, CI: 2.1-5.3, p<0.001). Atrial vulnerability did not significantly correlate with a higher risk of AF recurrence (OR: 4.8, CI: 0.7-29, p<0.008). Again, neither male gender (OR: 1.5, CI: 0.8-2.8, p<0.16) nor left atrial diameter (OR: 1.5, CI: 0.2-10, p<0.67) were significant risk factors for recurrence of AF. Conclusion Older age was the only significant predictor of AF recurrence after ablation of AVNRT or AVRT. Further studies are needed to determine the age cut-off at which concomitant pulmonary vein isolation would be beneficial in patients undergoing ablation of AVNRT/AVRT.
引言 房室结折返性心动过速（AVNRT）和房室折返性心动过速（AVRT）常与心房颤动（AF）相关。针对慢径或旁路进行治疗被提倡用于合并AF的情况。但在实际中，AF在消融术后常复发，可能是由于各种危险因素。本研究的目的是调查这些危险因素并检验它们在AF复发中的意义。
材料与方法 对Medline、Cochrane和ClinicalTrials.gov数据库进行了系统综述。对研究AVNRT或AVRT消融术后AF复发的文章进行了回顾。充分评估了发表偏倚，并对所有二分变量采用随机方法。最后，计算每个危险因素的比值比（OR）和置信区间（CI）。
结果 纳入了四项研究，共1308名参与者。只有218名参与者有双重心动过速（AF合并AVNRT或AVRT）。平均随访时间为29±3.3个月。平均年龄为56±15岁。年龄是AF复发的唯一显著危险因素（OR：3.4，CI：2.1 - 5.3，p<0.001）。心房易损性与AF复发风险较高无显著相关性（OR：4.8，CI：0.7 - 29，p<0.008）。同样，男性（OR：1.5，CI：0.8 - 2.8，p<0.16）和左心房直径（OR：1.5，CI：0.2 - 10，p<0.67）均不是AF复发的显著危险因素。
结论 年龄较大是AVNRT或AVRT消融术后AF复发的唯一显著预测因素。需要进一步研究以确定在AVNRT/AVRT消融患者中，同时进行肺静脉隔离有益的年龄界限。
