Charitakis Emmanouil, Metelli Silvia, Karlsson Lars O, Antoniadis Antonios P, Liuba Ioan, Almroth Henrik, Hassel Jönsson Anders, Schwieler Jonas, Sideris Skevos, Tsartsalis Dimitrios, Dragioti Elena, Fragakis Nikolaos, Chaimani Anna
Department of Cardiology, Linköping University Hospital, 581 85 Linköping, Sweden.
Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université de Paris, 75004 Paris, France.
Diagnostics (Basel). 2022 Feb 9;12(2):433. doi: 10.3390/diagnostics12020433.
Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65-0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46-0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2-2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies.
尽管导管消融术（CA）是阵发性心房颤动（PAF）的既定治疗方法，但对于最有效的CA策略尚无共识。这项网络荟萃分析（NMA）的目的是比较不同CA策略治疗PAF的疗效和安全性。在PubMed、科学网和CENTRAL中进行了系统检索，直至最终检索日期2020年10月5日。纳入了比较不同CA策略和肺静脉隔离（PVI）方法的随机对照试验（RCT）。疗效定义为CA术后无心律失常复发，安全性定义为在至少6个月的随访期内报告的与手术相关的任何并发症。总共纳入了43项RCT，比较了涉及6701例患者的11种不同CA策略。与仅采用射频的PVI相比，以下治疗方法的复发风险显著降低：辅助消融的PVI（RR：0.79，CI：0.65 - 0.97）和交感神经调制的PVI（RR：0.64，CI：0.46 - 0.88）。然而，射频PVI优于非PVI策略（RR：1.65，CI：1.2 - 2.26）。不同CA策略之间在安全性方面未发现统计学显著差异。关于不同的PVI策略，在测试策略之间的疗效和安全性方面均未观察到差异。这项NMA表明，不同的PVI策略在疗效方面通常相似，而附加消融或交感神经调制的PVI可能比单独的PVI更有效。本研究为决策者提供了关于不同CA策略疗效和安全性的见解。
