Wang Tongyu, Fang Tingting, Cheng Zeyi
Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
Department of Cardiology, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.
Front Cardiovasc Med. 2022 Jun 3;9:853149. doi: 10.3389/fcvm.2022.853149. eCollection 2022.
Atrial fibrillation (AF) is a prevalent arrhythmia that occurs in 2-4% of adults and poses a threat to human health. Thus, comparison of the efficacy and safety of therapies for AF is warranted. Here, we used network analysis to compare efficacy (arrhythmia recurrence and re-hospitalization) and safety (ischemic cerebral vascular events, all-cause mortality, and cardiovascular mortality) endpoints among five major therapies for AF.
The PubMed, Cochrane, and Embase databases were searched, and relevant literature was retrieved. Only studies that made comparisons among the therapies of interest and involved patients with AF were included. Pairwise comparisons and frequentist method (SUCRA plot) analyses were conducted.
In total, 62 studies were included in the pooled analysis. In pairwise comparisons, atrioventricular nodal ablation plus permanent pacemaker (AVN + PPM) was associated with a significantly higher risk of atrial arrhythmia recurrence than surgical ablation [odds ratio (OR): 23.82, 95% confidence interval (CI): 1.97-287.59, fixed-effect model; 3.82, 95% CI: 1.01-559.74, random-effects model]. Furthermore, radiofrequency ablation was associated with a significantly lower risk of cardiovascular mortality than medication in pairwise comparison (OR: 0.49, 95% CI: 0.29-0.83, fixed-effect model; OR: 0.49, 95% CI: 0.27-0.9, random-effects model). Frequentist analysis indicated that AVN + PPM had the best performance in reducing the risk of safety and efficacy endpoints.
Non-pharmaceutical therapies showed superior performance to traditional drug therapy in lowering the risk of safety and efficiency endpoint events. AVN + PPM performed best in reducing the risk of safety and efficacy endpoints.
心房颤动（AF）是一种常见的心律失常，在2%至4%的成年人中发生，对人类健康构成威胁。因此，有必要比较房颤治疗方法的疗效和安全性。在此，我们使用网络分析来比较房颤五种主要治疗方法在疗效（心律失常复发和再住院）和安全性（缺血性脑血管事件、全因死亡率和心血管死亡率）终点方面的情况。
检索了PubMed、Cochrane和Embase数据库，并检索了相关文献。仅纳入对感兴趣的治疗方法进行比较且涉及房颤患者的研究。进行了成对比较和频率法（SUCRA图）分析。
汇总分析共纳入62项研究。在成对比较中，房室结消融加永久起搏器（AVN + PPM）与心房心律失常复发风险显著高于手术消融相关[优势比（OR）：23.82，95%置信区间（CI）：1.97 - 287.59，固定效应模型；3.82，95% CI：1.01 - 559.74，随机效应模型]。此外，在成对比较中，射频消融与心血管死亡率显著低于药物治疗相关（OR：0.49，95% CI：0.29 - 0.83，固定效应模型；OR：0.49，95% CI：0.27 - 0.9，随机效应模型）。频率分析表明，AVN + PPM在降低安全性和疗效终点风险方面表现最佳。
非药物治疗在降低安全性和有效性终点事件风险方面表现优于传统药物治疗。AVN + PPM在降低安全性和疗效终点风险方面表现最佳。
