Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.
Department of Cardiology, Zibo Central, Zibo, China.
Interact Cardiovasc Thorac Surg. 2020 Dec 7;31(6):763-773. doi: 10.1093/icvts/ivaa203.
There is an urgent need to understand the difference in the influence of thoracoscopic surgical ablation (TSA) and catheter ablation (CA) on clinical outcomes in patients with atrial fibrillation (AF). This meta-analysis of randomized controlled trials aimed to examine the efficacy and safety of TSA versus CA in patients with AF.
Databases including EMBASE, Clinical Trials, PubMed and Cochrane Central Registered Control System were screened for the retrieval of articles. A direct meta-analysis of TSA versus CA was conducted. The I2 test analysis was performed to evaluate heterogeneity. The Begg-Mazumdar test and the Harbord-Egger test were used to detect publication bias. The primary efficacy outcome was freedom from atrial tachyarrhythmia, while the primary safety outcome was severe adverse event (SAE) occurrence.
Of the 860 identified articles, 6, comprising 466 participants, were finally included. The rate of freedom from AT was higher in the TSA group (75%) than in the CA group (57.1%) (odds ratio 0.41; 95% confidence interval 0.2-0.85; P = 0.02; I2 = 57%). A larger number of SAEs were observed in the TSA group than in the CA group (odds ratio 0.16; 95% confidence interval 0.006-0.46; P = 0.0006; I2 = 44%). The result of the subgroup analysis of 3 studies that enrolled AF patients without a history of ablation showed that the incidence of AT was comparable in both arms. The ablation procedure and hospitalization durations were longer in the TSA arm.
In our study, TSA was associated with better efficacy but a higher rate of SAEs compared to CA. In addition, TSA did not show better efficacy results as the first invasive procedure in the sub-analysis of patients with paroxysmal AF or early persistent AF. Therefore, doctors should recommend either TSA or CA to patients with AF after due consideration of the aforementioned findings.
迫切需要了解胸腔镜手术消融（TSA）和导管消融（CA）对心房颤动（AF）患者临床结局的影响差异。本荟萃分析旨在评估 AF 患者 TSA 与 CA 的疗效和安全性。
检索 EMBASE、ClinicalTrials、PubMed 和 Cochrane 中央对照试验注册数据库，筛选出文章。对 TSA 与 CA 进行直接荟萃分析。采用 I2 检验分析评估异质性。采用 Begg-Mazumdar 检验和 Harbord-Egger 检验检测发表偏倚。主要疗效结局为无房性快速心律失常，主要安全性结局为严重不良事件（SAE）发生。
在 860 篇文章中，最终有 6 篇，共 466 例患者被纳入。TSA 组（75%）的无 AT 率高于 CA 组（57.1%）（比值比 0.41；95%置信区间 0.2-0.85；P=0.02；I2=57%）。TSA 组观察到的 SAE 更多（比值比 0.16；95%置信区间 0.006-0.46；P=0.0006；I2=44%）。纳入 3 项未行消融治疗史的 AF 患者研究的亚组分析显示，两组的 AT 发生率相当。TSA 组的消融程序和住院时间更长。
与 CA 相比，TSA 与更好的疗效相关，但 SAE 发生率更高。此外，在阵发性 AF 或早期持续性 AF 患者的亚组分析中，TSA 作为首次侵入性操作并未显示出更好的疗效结果。因此，医生应在考虑上述结果的基础上，向 AF 患者推荐 TSA 或 CA。
