Heart Center, the First Hospital of Lanzhou University, Lanzhou, China.
the First Clinical Medical School, Lanzhou University, Lanzhou, China.
Pacing Clin Electrophysiol. 2021 Jul;44(7):1151-1162. doi: 10.1111/pace.14263. Epub 2021 May 24.
Contemporary radiofrequency catheter ablation (RFCA) approaches for atrial fibrillation (AF) have reached an efficacy "ceiling". Ethanol infusion into the vein of Marshall (EI-VOM) has shown potential in preliminary studies. Data on EI-VOM are largely limited to small single-center reports, and clinical benefits and risks have not been systematically examined. Therefore, we performed a meta-analysis to assess the feasibility, efficacy, and safety of EI-VOM for AF.
All studies evaluating EI-VOM for AF were initially searched from four electronic search engines: PubMed, Web of Science, Cochrane Library, and SinoMed. We used RevMan5.4 to calculate pooled outcomes of randomized controlled trial and cohort studies. We also performed single-arm meta-analyses using Open Meta-Analyst.
We included a total of 10 studies with 1322 patients. Successful EI-VOM was performed in 86.7% (95% CI 81.9-91.4%) of patients. For persistent AF patients, the recurrence of AF and/or atrial tachycardia (AT) was significantly lower in the EI-VOM combined with RFCA group compared with RFCA alone group (RR 0.58, 95% CI 0.35 to 0.96, p = 0.04). EI-VOM combined with RFCA significantly increased the rate of bidirectional mitral isthmus block compared with RFCA alone in AF patients (RR 1.50, 95% CI 1.34 to 1.67, p < 0.001). There were nine cardiac tamponades observed in 644 patients (PR 0.8%, 95% CI 0.1-1.5%) who were performed EI-VOM combined with RFCA.
Our meta-analysis brings encouraging evidence that adjuvant EI-VOM reduces AF and/or AT recurrence rate in persistent AF patients and increases the success rate of bidirectional mitral isthmus block.
目前，针对心房颤动（房颤）的射频导管消融（RFCA）方法已经达到了疗效的“上限”。Marshall 静脉内乙醇输注（EI-VOM）在初步研究中显示出了潜力。关于 EI-VOM 的数据主要限于小的单中心报告，其临床获益和风险尚未得到系统评估。因此，我们进行了一项荟萃分析，以评估 EI-VOM 治疗房颤的可行性、疗效和安全性。
最初从四个电子搜索引擎（PubMed、Web of Science、Cochrane 图书馆和 SinoMed）中搜索了所有评估 EI-VOM 治疗房颤的研究。我们使用 RevMan5.4 计算了随机对照试验和队列研究的汇总结果。我们还使用 Open Meta-Analyst 进行了单臂荟萃分析。
我们共纳入了 10 项研究，共计 1322 例患者。在 86.7%（95%置信区间 81.9-91.4%）的患者中成功实施了 EI-VOM。对于持续性房颤患者，EI-VOM 联合 RFCA 组的房颤和/或房性心动过速（AT）复发率明显低于 RFCA 组（RR 0.58，95%CI 0.35 至 0.96，p=0.04）。与 RFCA 组相比，EI-VOM 联合 RFCA 可显著增加房颤患者的双向二尖瓣峡部阻滞率（RR 1.50，95%CI 1.34 至 1.67，p<0.001）。在 644 例接受 EI-VOM 联合 RFCA 的患者中，观察到 9 例心脏压塞（PR 0.8%，95%CI 0.1-1.5%）。
我们的荟萃分析带来了令人鼓舞的证据，表明辅助 EI-VOM 可降低持续性房颤患者的房颤和/或 AT 复发率，并提高双向二尖瓣峡部阻滞的成功率。
