Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.
Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jingwulu Jinan 250010, Jinan, Shandong Province, China.
J Interv Card Electrophysiol. 2023 Apr;66(3):757-770. doi: 10.1007/s10840-022-01246-5. Epub 2022 Jul 4.
Catheter ablation has been recommended as the first-line treatment option for selected patients with atrial fibrillation (AF). However, a widely accepted ablation strategy for persistent AF (perAF) has not yet been established. The benefits of ablation strategies are not conclusive for perAF. There is an urgent need to systematically analyze the results of previous studies and rank these treatment strategies to guide clinical practice.
Randomized controlled trials (RCTs) on ablation for perAF were included. The primary outcome was recurrence of atrial tachyarrhythmia (AT) after a single ablation procedure. A Bayesian random-effects network meta-analysis model was fitted.
Twenty-three studies were included in the analysis. A total of 3394 patients and 22 ablation strategies were found in the involved studies. The ablation strategy of pulmonary vein isolation (PVI) + electrical box isolation of the left atrial posterior wall (PBOX) + non-PV trigger ablation (NPV) showed the best treatment effect in terms of the primary outcome. The individualized ablation strategies of mapping and ablation combined with PVI, such as PVI + rotors, PVI + dispersion areas, and PVI + low voltage zone (LVZ) also showed a better ablation effect in perAF.
PVI ablation is a widely used strategy in perAF and is recognized as a cornerstone procedure for perAF. The PVI + PBOX + NPV strategy showed the highest rank in our analysis. Mapping and ablation strategies that could provide individualized substrate modification also showed a better rank in our analysis and are believed to be a promising direction for the treatment of perAF.
导管消融已被推荐作为某些心房颤动（房颤）患者的一线治疗选择。然而，对于持续性房颤（perAF）尚未建立广泛接受的消融策略。消融策略对 perAF 的益处尚无定论。迫切需要系统分析以往研究的结果并对这些治疗策略进行排名，以指导临床实践。
纳入了针对 perAF 的消融的随机对照试验（RCT）。主要结局是单次消融后心房性快速心律失常（AT）的复发。拟合了贝叶斯随机效应网络荟萃分析模型。
分析纳入了 23 项研究。涉及的研究共发现了 3394 名患者和 22 种消融策略。在主要结局方面，肺静脉隔离（PVI）+左心房后壁电盒隔离（PBOX）+非 PV 触发消融（NPV）的消融策略显示出最佳的治疗效果。PVI 联合标测和消融的个体化消融策略，如 PVI+转子、PVI+弥散区和 PVI+低电压区（LVZ），在 perAF 中也显示出更好的消融效果。
PVI 消融是 perAF 中广泛应用的策略，被认为是 perAF 的基石性手术。PVI+PBOX+NPV 策略在我们的分析中排名最高。能够提供个体化基质修饰的标测和消融策略在我们的分析中也显示出更好的排名，被认为是 perAF 治疗的有前途的方向。
