Muhammad Zia Khan, Safi U Khan, Adeel Arshad, Muhammad Samsoor Zarak, Muhammad U Khan, Muhammad Shahzeb Khan, Edo Kaluski, Mohamad Alkhouli
Department of Medicine, West Virginia University, Morgantown, WV, USA.
Rochester Regional Health/Unity Hospital, Rochester, NY.
J Atr Fibrillation. 2020 Apr 30;12(6):2266. doi: 10.4022/jafib.2266. eCollection 2020 Apr-May.
Catheter ablation has shown to reduce mortality in patient with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction. Its effect on mortality in patients without HF has not been well elucidated.
Thirteen randomized controlled trials encompassing 3856 patients were selected using PubMed, Embase and the CENTRAL till April 2019. Estimates were reported as random effects risk ratio (RR) with 95% confidence intervals (CI).
Compared with medical therapy, catheter ablation did not reduce the risk of all-cause mortality (RR, 0.86, 95% CI, 0.62-1.19, P=0.36; I2=0), stroke (RR, 0.55, 95% CI, 0.18-1.66, P=0.29; I2=0), need for cardioversion (RR, 0.84, 95% CI, 0.66-1.08, P=0.17; I2=0) or pacemaker (RR, 0.59, 95% CI, 0.34-1.01, P=0.06; I2=0). However, ablation reduced the RR of cardiac hospitalization (0.37, 95% CI, 0.18-0.77, P=0.01; I2=86), and recurrent atrial arrhythmia (0.46, 95% CI, 0.35-0.60, P<0.001; I2=87). There were non-significant differences among treatment groups with respect to major bleeding (RR, 1.89, 95% CI, 0.59-6.08, P=0.29; I2=15), and pulmonary vein stenosis (RR, 3.00, 95% CI, 0.83-10.87, P=0.09; I2=0), but had significantly higher rates of pericardial tamponade (RR, 4.46, 95 % CI, 1.70-11.72, P<0.001; I2=0).
Catheter ablation did not improve survival compared with medical therapy in patients with AF without HF. Catheter ablation reduced cardiac hospitalization and recurrent atrial arrhythmia at the expense of pericardial tamponade.
导管消融已被证明可降低射血分数降低的房颤（AF）和心力衰竭（HF）患者的死亡率。其对无HF患者死亡率的影响尚未得到充分阐明。
截至2019年4月，使用PubMed、Embase和CENTRAL筛选了13项随机对照试验，共纳入3856例患者。估计值报告为随机效应风险比（RR）及95%置信区间（CI）。
与药物治疗相比，导管消融并未降低全因死亡率（RR，0.86；95%CI，0.62 - 1.196；P = 0.36；I² = 0）、卒中（RR，0.55；95%CI，0.18 - 1.66；P = 0.29；I² = 0）、复律需求（RR，0.84；95%CI，0.66 - 1.08；P = 0.17；I² = 0）或起搏器植入需求（RR，0.59；95%CI，0.34 - 1.01；P = 0.06；I² = 0）。然而，消融降低了心脏住院的RR（0.37；95%CI，0.18 - 0.77；P = 0.01；I² = 86）以及房性心律失常复发的RR（0.46；95%CI，0.35 - 0.60；P < 0.001；I² = 87）。各治疗组在大出血（RR，1.89；95%CI，0.59 - 6.08；P = 0.29；I² = 15）和肺静脉狭窄（RR，3.00；95%CI，0.83 - 10.87；P = 0.09；I² = 0）方面无显著差异，但心包填塞发生率显著更高（RR，4.46；95%CI，1.70 - 11.72；P < 0.001；I² = 0）。
对于无HF的AF患者，与药物治疗相比，导管消融并未改善生存率。导管消融降低了心脏住院率和房性心律失常复发率，但以心包填塞为代价。
