Department of Medicine and Surgery, Ospedale di Circolo, University of Insubria, Varese, Italy.
Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy.
J Cardiovasc Electrophysiol. 2020 Oct;31(10):2632-2641. doi: 10.1111/jce.14666. Epub 2020 Jul 16.
Data regarding catheter ablation (CA) of atrial tachycardias (ATs) occurring after mitral valve surgery (MVS) are scarce. The aim of this study was to assess the safety and efficacy of CA of ATs in this surgical population through a systematic review of the literature and meta-analysis.
A systematic search on PubMed/MEDLINE, EMBASE, and Web of Science was performed considering patients undergoing CA for ATs occurring after MVS. Periprocedural thromboembolic and hemorrhagic complications were assessed. The acute success and maintenance of sinus rhythm (SR) at a mid (<24 months) and long-term follow-up (FU) after CA were investigated along with the burden of arrhythmic recurrence at FU.
Fourteen studies for a total of 227 patients were considered. Three-dimensional (3D) mapping systems were used in all studies. Only two major bleedings were recorded with a pooled estimate of periprocedural major complications of 0%. The acute success after CA was 95% with a clear improvement over time. Although maintenance of SR was 71% at a midterm FU, long-term efficacy was as low as 47% due to an increased burden of atrial fibrillation (AF) recurrence despite multiple procedures/patient.
In this meta-analysis, CA of postsurgical ATs after MVS proved safe and effective but with still a significant burden of AF recurrence at more than 24 months of FU due to a progressive atrial substrate deterioration. The improvement of procedural success over time might suggest a learning curve in optimizing the use of 3D mapping systems.
关于二尖瓣手术后（MVS）发生的房性心动过速（ATs）行导管消融（CA）的数据很少。本研究的目的是通过对文献的系统回顾和荟萃分析，评估 CA 在该手术人群中治疗 AT 的安全性和有效性。
在 PubMed/MEDLINE、EMBASE 和 Web of Science 上进行了系统搜索，纳入了 MVS 后因 AT 而行 CA 的患者。评估了围手术期血栓栓塞和出血并发症。研究了 CA 后即刻窦性心律（SR）的成功率和中期（<24 个月）及长期（随访）的 SR 维持率，以及随访时心律失常复发的负担。
共纳入 14 项研究，共计 227 例患者。所有研究均使用了三维（3D）标测系统。仅记录到 2 例大出血，围手术期主要并发症的合并估计发生率为 0%。CA 后的即刻成功率为 95%，且随着时间的推移呈明显改善趋势。尽管中期随访时 SR 的维持率为 71%，但由于尽管多次行消融术/患者，但心房颤动（AF）复发的负担增加，长期疗效仅为 47%。
在这项荟萃分析中，MVS 后手术性 ATs 的 CA 被证明是安全有效的，但由于心房基质逐渐恶化，在超过 24 个月的 FU 时仍有明显的 AF 复发负担。随着时间的推移，手术成功率的提高可能表明在优化使用 3D 标测系统方面存在学习曲线。
