Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Cardiovasc Electrophysiol. 2021 Nov;32(11):3068-3081. doi: 10.1111/jce.15230. Epub 2021 Sep 3.
Combined ablation and left atrial appendage closure (LAAC) is an alternative for atrial fibrillation patients with a high risk of stroke. However, the long-term outcomes of this combined procedure remain elusive.
PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included.
A total of 16 studies comprising 1428 patients were enrolled. The pooled long-term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI]: 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI: 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI: 0.00-0.02). Meanwhile, of the periprocedural adverse events, phrenic nerve palsy, intracoronary air embolus, device embolization, and periprocedural death had a rate of 0.00 (95% CI: 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI: 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI: 0.00-0.01). Moreover, for the long-term adverse events, device dislocation, intracranial bleeding, pericardial effusion requiring or not requiring intervention, and all-cause mortality had a rate of 0.00 (95% CI: 0.00-0.00), device embolization of 0.01 (95% CI: 0.00-0.01), and other bleeding events of 0.01 (95% CI: 0.00-0.03).
This meta-analysis suggests that the combined atrial ablation and LAAC is an effective and safe strategy with long-term benefits.
对于存在较高卒中风险的房颤患者，联合消融与左心耳封堵术（LAAC）是一种替代治疗方法。然而，这种联合术式的长期疗效和安全性仍不明确。
系统检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science 从数据库建立到 2021 年 1 月 1 日的数据，纳入了关于联合消融与 LAAC 长期（定义为平均随访时间约 12 个月或更长时间）疗效和安全性结局的研究。
共纳入 16 项研究，共计 1428 例患者。汇总的长期房性心律失常无复发率为 0.66（95%置信区间[CI]：0.59-0.71），LAAC 长期完全封堵率为 1.00（95%CI：1.00-1.00），随访期间缺血性卒中和短暂性脑缺血发作/系统性栓塞发生率为 0.01（95%CI：0.00-0.02）。同时，围手术期不良事件中膈神经麻痹、冠状动脉气栓、器械栓塞和围手术期死亡的发生率为 0.00（95%CI：0.00-0.00），手术相关出血事件的发生率为 0.03（95%CI：0.02-0.04），需要或不需要干预的心包积液发生率为 0.00（95%CI：0.00-0.01）。此外，对于长期不良事件，器械脱位、颅内出血、需要或不需要干预的心包积液以及全因死亡率的发生率为 0.00（95%CI：0.00-0.00），器械栓塞的发生率为 0.01（95%CI：0.00-0.01），其他出血事件的发生率为 0.01（95%CI：0.00-0.03）。
本荟萃分析表明，联合心房消融与 LAAC 是一种有效且安全的策略，具有长期获益。
