Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, Zhejiang, China.
PLoS One. 2022 Jan 19;17(1):e0262702. doi: 10.1371/journal.pone.0262702. eCollection 2022.
The prevailing view is that ablation does not reduce the incidence of stroke and deaths in atrial fibrillation (AF), and guidelines suggest that long-term anticoagulation is required after ablation, regardless of the success of the procedure. We performed a meta-analysis of recent randomized, controlled trials (RCTs) to verify whether ablation compared with drugs reduced the incidence of stroke and deaths.
We systematically searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases for RCTs of AF catheter ablation (CA) compared to medical therapy (MT). The risk ratio (RR) and weighted mean difference (WMD) with 95% CIs were calculated using a random-effects model. A trial sequential analysis (TSA) was used to further validate the reliability of the primary outcomes.
Seventeen RCTs were included, comprising 5,258 patients (CA, n = 2760; MT, n = 2498). Compared with medical therapy, CA was associated with a reduction in stroke/transient ischaemic attacks (TIAs) (p = 0.035; RR = 0.61 [95% CI, 0.386 to 0.965]; I2 = 0.0%) and deaths (p = 0.004; RR = 0.7 [95% CI, 0.55 to 0.89]; I2 = 0.0%). CA was associated with improvement in left ventricular ejection fraction (LVEF) (p = 0.000; WMD = 5.39 [95% CI, 2.45 to 8.32]; I2 = 84.4%) and the rate of maintenance of sinus rhythm (SR) (p = 0.000; RR = 3.55 [95% CI, 2.34 to 5.40]; I2 = 76.7%).
CA for AF had more favourable outcomes in terms of stroke/TIAs, deaths, change in LVEF, and the maintenance of SR at the end of follow-up compared to MT. Besides, the TSA results supported this conclusion.
目前的观点认为，消融术不能降低房颤（AF）患者中风和死亡的发生率，并且指南建议，无论手术是否成功，消融术后都需要长期抗凝。我们对最近的随机对照试验（RCT）进行了荟萃分析，以验证消融术与药物治疗相比是否能降低中风和死亡的发生率。
我们系统地检索了 PubMed、Embase 和 Cochrane 对照试验中心注册数据库，以获取 AF 导管消融（CA）与药物治疗（MT）的 RCT 研究。使用随机效应模型计算风险比（RR）和加权均数差（WMD）及其 95%置信区间（CI）。采用试验序贯分析（TSA）进一步验证主要结局的可靠性。
纳入了 17 项 RCT，共纳入 5258 例患者（CA 组 2760 例，MT 组 2498 例）。与药物治疗相比，CA 组中风/短暂性脑缺血发作（TIA）的发生率降低（p = 0.035；RR = 0.61 [95%CI，0.386 至 0.965]；I2 = 0.0%），死亡率降低（p = 0.004；RR = 0.7 [95%CI，0.55 至 0.89]；I2 = 0.0%）。CA 组左心室射血分数（LVEF）改善（p = 0.000；WMD = 5.39 [95%CI，2.45 至 8.32]；I2 = 84.4%），窦性节律（SR）维持率提高（p = 0.000；RR = 3.55 [95%CI，2.34 至 5.40]；I2 = 76.7%）。
与 MT 相比，AF 的 CA 治疗在中风/TIA、死亡、LVEF 变化和随访结束时 SR 的维持方面具有更好的结局。此外，TSA 结果支持这一结论。
