Department of Cardiology, Memphis VA Medical Center, 1030 Jefferson Ave, Memphis, TN, 38104.
School of Public Health, The University of Memphis, Memphis, TN, USA.
Pacing Clin Electrophysiol. 2021 Jan;44(1):54-62. doi: 10.1111/pace.14129. Epub 2020 Nov 30.
Catheter ablation is an effective treatment for ventricular arrhythmia (VA) in ischemic cardiomyopathy (ICM). However, results in non-ICM (NICM) patients are not satisfactory, and studies comparing differences between NICM and ICM are limited. We conducted a meta-analysis of procedural characteristics and long-term outcomes of catheter ablation for VA, comparing results between ICM and NICM.
Studies in the PubMed, EMBASE, and Cochrane databases were systematically reviewed. Four studies reporting comparison of catheter ablation of VA between ICM and NICM were examined. The Newcastle-Ottawa Scale was used to appraise study quality. A random-effects model with inverse variance method was used for comparisons.
Epicardial approach was significantly more undertaken for the NICM group than in the ICM group (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.09-0.18; P < .00001). Mean ablation time (P = .54), fluoroscopy time (P = .55), and procedural time (P = .18) did not differ significantly between the ICM and NICM groups. Procedural failure rates (OR: 0.46; 95% CI: 0.24-0.89; P = .02) and VA recurrence rates (risk ratio [RR]: 0.68; 95% CI: 0.46-1.01; P = .06) were significantly higher in the NICM group than in the ICM group. However, all-cause mortality (RR: 1.37; 95% CI: 0.75-2.49; P = .31) did not differ significantly between groups.
Procedural failure and VA recurrence rates were significantly higher in the NICM group, despite significantly more frequent epicardial access. These highlight the limitations of catheter ablation for VA in NICM, given our current knowledge.
导管消融是缺血性心肌病（ICM）患者室性心律失常（VA）的有效治疗方法。然而，非缺血性心肌病（NICM）患者的结果并不令人满意，并且比较 NICM 和 ICM 之间差异的研究有限。我们对导管消融治疗 VA 的程序特征和长期结果进行了荟萃分析，比较了 ICM 和 NICM 之间的结果。
系统地回顾了 PubMed、EMBASE 和 Cochrane 数据库中的研究。检查了四项报告比较 ICM 和 NICM 之间 VA 导管消融的研究。使用纽卡斯尔-渥太华量表评估研究质量。采用具有逆方差法的随机效应模型进行比较。
心外膜入路在 NICM 组中明显多于 ICM 组（比值比 [OR]：0.13；95%置信区间 [CI]：0.09-0.18；P<0.00001）。两组间平均消融时间（P=0.54）、透视时间（P=0.55）和手术时间（P=0.18）无显著差异。程序失败率（OR：0.46；95%CI：0.24-0.89；P=0.02）和 VA 复发率（风险比 [RR]：0.68；95%CI：0.46-1.01；P=0.06）在 NICM 组明显高于 ICM 组。然而，两组间全因死亡率（RR：1.37；95%CI：0.75-2.49；P=0.31）无显著差异。
尽管心外膜入路更为频繁，但 NICM 组的程序失败率和 VA 复发率明显更高。鉴于我们目前的知识，这凸显了导管消融治疗 NICM 患者 VA 的局限性。
