Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Chazhong Road NO.20, Fuzhou, 350000, Fujian, P. R. China.
Department of Anesthesiology, First Affiliated Hospital of Fujian Medical University, Chazhong Road NO.20, Fuzhou, 350000, Fujian, P. R. China.
Rev Cardiovasc Med. 2020 Sep 30;21(3):419-432. doi: 10.31083/j.rcm.2020.03.60.
Several observational studies have shown a survival benefit for patients with atrial fibrillation (AF) who are treated with catheter ablation (CA) rather than medical management (MM). However, data from randomized controlled trials (RCTs) are uncertain. Therefore, we performed a meta-analysis of RCTs that compared the benefits of CA and MM in treatment of AF. We searched the Cochrane Library, PubMed, and EMBASE databases for RCTs that compared AF ablation with MM from the time of database establishment up to January 2020. The risk ratio (RR) with a 95% confidence interval (CI) was used as a measure treatment effect. Twenty-six RCTs that enrolled a total of 5788 patients were included in the meta-analysis. In this meta-analysis, the effect of AF ablation depended on the baseline level of left ventricular ejection fraction (LVEF) in the heart failure (HF) patients. AF ablation appears to be of benefit to patients with a lesser degree of advanced HF and better LVEF by reducing mortality. Meanwhile, this mortality advantage was manifested in long-term follow-up. CA increased the risk for hospitalization when it was used as first-line therapy and decreased the risk when used as second-line therapy. CA reduced recurrence of atrial arrhythmia for different types of AF (paroxysmal or persistent AF) and CA-related complications were non-negligible. There was no convincing evidence for a reduction in long-term stroke risk after AF ablation, and additional high quality RCTs are needed to address that issue.
几项观察性研究表明，与接受药物治疗（MM）相比，接受导管消融（CA）治疗的心房颤动（AF）患者具有生存获益。然而，随机对照试验（RCT）的数据并不确定。因此，我们对比较 CA 和 MM 治疗 AF 效果的 RCT 进行了荟萃分析。我们检索了 Cochrane 图书馆、PubMed 和 EMBASE 数据库，从数据库建立时间到 2020 年 1 月，检索比较 AF 消融与 MM 的 RCT。使用风险比（RR）及其 95%置信区间（CI）作为治疗效果的衡量指标。荟萃分析纳入了 26 项 RCT，共纳入 5788 例患者。在这项荟萃分析中，AF 消融的效果取决于心力衰竭（HF）患者的左心室射血分数（LVEF）基线水平。通过降低死亡率，AF 消融似乎对心力衰竭程度较轻且 LVEF 较好的患者有益。同时，这种死亡率优势在长期随访中表现出来。CA 作为一线治疗时会增加住院风险，而作为二线治疗时会降低风险。CA 降低了不同类型 AF（阵发性或持续性 AF）的心房心律失常复发风险，CA 相关并发症不容忽视。AF 消融后长期卒中风险降低的证据不足，需要更多高质量的 RCT 来解决这一问题。
