Department of Cardiology, The First Hospital of China Medical University, Nanjing North Street No. 155, Heping District, Shenyang, 110001, China.
J Interv Card Electrophysiol. 2023 Sep;66(6):1519-1527. doi: 10.1007/s10840-022-01258-1. Epub 2022 Sep 3.
Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the recurrence rate of AF after pulmonary vein isolation (PVI) remains high. The efficacy and safety of low voltage area (LVA) ablation in the treatment of AF are uncertain.
The studies comparing the efficacy and safety of LVA ablation and LVA non-ablation for AF were systematically reviewed and meta-analyzed. Outcomes of interest included recurrent event, procedure time, and fluoroscopy time. Continuous variables were evaluated with mean deviation (MD) and standard mean difference (SMD). Odds ratio (OR) values and its 95% confidence intervals (CI) were used in meta-analysis of binary variables.
Fourteen studies were eligible for inclusion. The AF recurrence was similar between the two groups, with no statistical difference (25.7% (67/346) vs. 28% (63/225), P = 0.49). LVA ablation did not increase the incidence of AT (8.7% (20/231) vs. 14.5% (28/193), P = 0.66). Fluoroscopy time was longer in the LVA ablation group (31.4 ± 8.4 min vs. 26.3 ± 7.8 min, P < 0.05). Complication rates were similar between the two groups (26.6% (17/64) vs. 21.7% (13/60), P = 0.53). Patients with LVA had higher AT/AF recurrence (32.9% (213/647) vs. 24.2% (229/948), P < 0.05).
Patients with left atrial LVA have a poor prognosis after catheter ablation. LVA ablation did not reduce the recurrence of AF nor did it increase the recurrence of atrial tachycardia.
肺静脉隔离是心房颤动（AF）消融的基石。然而，肺静脉隔离（PVI）后 AF 的复发率仍然很高。低电压区（LVA）消融治疗 AF 的疗效和安全性尚不确定。
系统地回顾和荟萃分析了比较 LVA 消融与 LVA 非消融治疗 AF 的疗效和安全性的研究。感兴趣的结局包括复发事件、手术时间和透视时间。连续变量采用均差（MD）和标准化均差（SMD）进行评估。二分类变量采用比值比（OR）值及其 95%置信区间（CI）进行荟萃分析。
14 项研究符合纳入标准。两组之间的 AF 复发率相似，无统计学差异（25.7%（67/346）比 28%（63/225），P=0.49）。LVA 消融并未增加房性心动过速（AT）的发生率（8.7%（20/231）比 14.5%（28/193），P=0.66）。LVA 消融组透视时间较长（31.4±8.4 min 比 26.3±7.8 min，P<0.05）。两组并发症发生率相似（26.6%（17/64）比 21.7%（13/60），P=0.53）。LVA 患者的 AT/AF 复发率更高（32.9%（213/647）比 24.2%（229/948），P<0.05）。
左心房 LVA 患者导管消融后预后较差。LVA 消融并未降低 AF 的复发率，也未增加房性心动过速的复发率。
