Unni Rudy R, Prager Ross T, Odabashian Roupen, Zhang Jimmy J, Fat Hing Nicholas Ng, Nery Pablo B, Pi Lebei, Aldawood Wafa, Sadek Mouhannad M, Redpath Calum J, Birnie David H, Alqarawi Wael, Zagzoog Amin, Golian Mehrdad, Klein Andres, Ramirez F Daniel, Green Martin S, Chen Li, Visintini Sarah, Wells George A, Nair Girish M
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Medicine, Western University, London, Ontario, Canada.
CJC Open. 2022 Feb 10;4(5):488-496. doi: 10.1016/j.cjco.2022.02.001. eCollection 2022 May.
: The rhythm-monitoring strategy after catheter ablation (CA) for atrial fibrillation (AF) impacts the detection of atrial arrhythmia recurrence and is not well characterized. We performed a systematic review and meta-regression analysis to determine whether the duration and mode of rhythm monitoring after CA affects detection of atrial arrhythmia recurrence.
Databases were systematically searched for randomized controlled trials of adult patients undergoing first CA for AF from 2007 to 2021. Duration and strategy of rhythm monitoring were extracted. Meta-regression was used to identify any association between duration of monitoring and detection of atrial arrhythmia recurrence. The primary measure of outcome was single-procedure recurrence of atrial arrhythmia.
The search strategy yielded 57 trial arms from 56 randomized controlled trials comprising 5322 patients: 36 arms of patients with paroxysmal AF (PAF), and 21 arms of patients with persistent AF (PeAF) or both PAF/PeAF. Intermittent monitoring was associated with detection of significantly less atrial arrhythmia recurrence than continuous monitoring in PAF arms (31.2% vs 46.9%, = 0.001), but not in PeAF/PAF-PeAF combined arms (43.3% vs 63.6%, = 0.12). No significant relationship was seen between the duration of intermittent rhythm monitoring and atrial arrhythmia recurrence detection in either the PAF ( = 0.93) or PeAF/PAF-PeAF combined arms ( = 0.20).
Continuous rhythm monitoring detected higher atrial arrhythmia recurrence rates, compared to intermittent rhythm monitoring, in patients with PAF. The duration of intermittent monitoring did not show a statistically significant relationship to the yield of arrhythmia detection, in near identical cohorts of trial subjects undergoing similar interventions, with clinical and research implications.
心房颤动（AF）导管消融（CA）后的心律监测策略会影响房性心律失常复发的检测，但其特征尚不明确。我们进行了一项系统评价和meta回归分析，以确定CA后心律监测的持续时间和模式是否会影响房性心律失常复发的检测。
系统检索2007年至2021年接受首次AF-CA的成年患者的随机对照试验。提取心律监测的持续时间和策略。采用meta回归分析确定监测持续时间与房性心律失常复发检测之间的关联。主要结局指标是房性心律失常的单次手术复发率。
检索策略从56项随机对照试验中获得了57个试验组，共5322例患者：36个阵发性AF（PAF）患者组，21个持续性AF（PeAF）患者组或PAF/PeAF患者组。在PAF组中，间歇监测与房性心律失常复发检测率显著低于连续监测相关（31.2%对46.9%，P = 0.001），但在PeAF/PAF-PeAF合并组中无此差异（43.3%对63.6%，P = 0.12）。在PAF组（P = 0.93）或PeAF/PAF-PeAF合并组（P = 0.20）中，间歇心律监测的持续时间与房性心律失常复发检测之间均未发现显著关系。
与间歇心律监测相比，连续心律监测在PAF患者中检测到更高的房性心律失常复发率。在接受类似干预的近乎相同的试验对象队列中，间歇监测的持续时间与心律失常检测率之间未显示出统计学上的显著关系，具有临床和研究意义。
