Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Cardiovasc Electrophysiol. 2022 Oct;33(10):2152-2163. doi: 10.1111/jce.15617. Epub 2022 Jul 23.
Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video-assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta-analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF.
We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video-assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed-effects, generic inverse variance method of DerSimonian, and Laird to calculate odds ratios and 95% confidence intervals.
Six studies from November 2013 to 2020 were included in this meta-analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56 ± 3 years) and 248 surgical ablations (mean age 52 ± 4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk = 1.85, 95% confidence interval: 1.44-2.39, p < .001, I = 0.0%) but associated with less total major adverse events (pooled relative risk = 0.29, 95% confidence interval: 0.16-0.53, p < .001, I = 0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk = 2.47, 95% confidence interval: 1.31-4.65, p = .005, I = 0.0%) but not in persistent AF (relative risk = 1.09, 95% confidence interval: 0.60-2.0, p = .773).
Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted.
心房颤动（AF）是最常见的心律失常，具有较高的中风和死亡率。视频辅助胸腔镜射频肺静脉消融是导管消融失败患者的一种治疗选择。比较手术与导管消融的随机数据有限。我们对随机对照试验进行了荟萃分析，以探讨 AF 患者中手术与导管射频肺静脉消融之间的疗效。
我们全面检索了 MEDLINE 和 EMBASE 数据库，检索时间从建库到 2020 年 12 月。纳入的研究为比较视频辅助胸腔镜和导管射频肺静脉消融的随机对照试验。使用 DerSimonian 和 Laird 的固定效应、通用逆方差方法对每项研究的数据进行合并，以计算比值比和 95%置信区间。
这项荟萃分析纳入了 6 项研究，时间为 2013 年 11 月至 2020 年，共涉及 511 例 AF 患者（79%为阵发性），其中 263 例接受了导管消融（平均年龄 56±3 岁），248 例接受了手术消融（平均年龄 52±4 岁）。与手术消融相比，导管消融与心房心律失常复发的相关性更高（合并相对风险=1.85，95%置信区间：1.44-2.39，p<0.001，I²=0.0%），但总主要不良事件的相关性较低（合并相对风险=0.29，95%置信区间：0.16-0.53，p<0.001，I²=0.0%）。亚组分析显示，与手术消融相比，导管消融在难治性阵发性 AF 中与 AF 复发的相关性更高（合并相对风险=2.47，95%置信区间：1.31-4.65，p=0.005，I²=0.0%），但在持续性 AF 中无相关性（相对风险=1.09，95%置信区间：0.60-2.0，p=0.773）。
与手术消融相比，导管消融与更高的心房心律失常复发率相关。然而，我们的研究表明，手术消融在持续性 AF 患者中的获益尚不清楚。需要更多的研究和对持续性 AF 的替代消融策略的探索。
