Deshpande Radhika, AlKhadra Yasser, Singanallur Prashanth, Botchway Albert, Labedi Mohamed
Department of Internal Medicine, Memorial Medical Center, Southern Illinois University School of Medicine, N 1st St, Springfield, IL, 62781, USA.
Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, IL, USA.
J Interv Card Electrophysiol. 2022 Dec;65(3):773-802. doi: 10.1007/s10840-022-01365-z. Epub 2022 Sep 3.
Recent data have shown an advantage of rhythm control over rate control for the treatment of atrial fibrillation (AF). Nevertheless, the data regarding efficacy of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) in patients with AF is lacking. Therefore, we sought to evaluate recurrence of arrhythmia, all-cause mortality, cardiovascular deaths, stroke/TIA, and all-cause readmissions of CA compared with AAD in patients with AF.
Systematically searched through PubMed, Google Scholar, EMBASE, and Cochrane for randomized control trials that compared CA and AAD in atrial fibrillation patients. Review Manager 5.4 and OpenMetaAnalyst were used to analyze the data. Data was pooled for the outcomes using random-effect models (DerSimonian and Laird) and reported as pooled odds ratio (OR).
A total of 4822 patients were included. The CA group had 2417 patients while the AAD group included 2405 patients. Pooled data demonstrated that the CA arm had a statistically significant decrease in risk for recurrence of arrhythmia as compared to AAD (OR 0.25; [95% CI, 0.18-0.36]; p < 0.001). All-cause readmission was statistically significantly lower in CA as compared to AAD (OR 0.33; [95%CI, 0.17-0.63]; p < 0.001). For other secondary outcomes, there was no statistically significant difference between CA and AAD with regard to all-cause mortality (OR 0.75; [95% CI, 0.55-1.03]), cardiovascular death (OR 0.76; [95% CI, 0.22-2.54]), bleeding (OR 1.09, [95% CI 0.74, 1.61]), or stroke/TIA outcome (OR 0.90, [95% CI, 0.59-1.37]).
In this study of pooled data from 16 RCTs, CA utilization for atrial fibrillation had improved freedom from arrhythmia as well as reduced all-cause readmission compared with AAD.
近期数据显示，在心房颤动（AF）治疗中，节律控制优于心率控制。然而，关于导管消融（CA）与抗心律失常药物（AADs）对AF患者疗效的相关数据尚缺。因此，我们旨在评估AF患者中，CA与AAD相比，心律失常复发、全因死亡率、心血管死亡、卒中/短暂性脑缺血发作（TIA）以及全因再入院情况。
通过PubMed、谷歌学术、EMBASE和Cochrane系统检索比较AF患者中CA与AAD的随机对照试验。使用Review Manager 5.4和OpenMetaAnalyst分析数据。采用随机效应模型（DerSimonian和Laird）汇总结局数据，并报告为汇总比值比（OR）。
共纳入4822例患者。CA组有2417例患者，AAD组有2405例患者。汇总数据表明，与AAD相比，CA组心律失常复发风险有统计学显著降低（OR 0.25；[95%CI，0.18 - 0.36]；p < 0.001）。与AAD相比，CA组全因再入院率在统计学上显著更低（OR 0.33；[95%CI，0.17 - 0.63]；p < 0.001）。对于其他次要结局，CA与AAD在全因死亡率（OR 0.75；[95%CI，0.55 - 1.03]）、心血管死亡（OR 0.76；[95%CI，0.22 - 2.54]）、出血（OR 1.09，[95%CI 0.74，1.61]）或卒中/TIA结局（OR 0.90，[95%CI，0.59 - 1.37]）方面无统计学显著差异。
在这项对16项随机对照试验汇总数据的研究中，与AAD相比，AF患者使用CA可改善心律失常的缓解情况，并降低全因再入院率。
