Liu Xiaohua, Gao Xiaofei, Chen Lian, Shen Lishui, Liu Meijun, Xu Yizhou
Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Pacing Clin Electrophysiol. 2022 Oct;45(10):1268-1276. doi: 10.1111/pace.14591. Epub 2022 Sep 20.
The clinical outcomes of pulmonary venous isolation alone for persistent atrial fibrillation (PerAF) remain unclear. Adjuvant posterior wall isolation (PWI) has become a potential supplementary strategy for improving the outcome of PerAF ablation. This meta-analysis aimed to evaluate the effect of PWI added to catheter ablation for PerAF.
PubMed, EMBASE, and Cochrane Library databases were searched for studies comparing the outcomes of PerAF ablation with and without PWI. The efficacy outcomes were recurrence of atrial arrhythmia (AA), atrial fibrillation (AF), and atrial tachycardia (AT), and the safety outcome was adverse events.
In total, eight studies with 1428 patients were included in the pooled analyses. The results showed that PWI significantly reduced the recurrence of AA (RR = 0.69, 95% CI = 0.55-0.87, p = .002, I = 63%) and AF (RR = 0.57, 95% CI = 0.40-0.80, p = .001, I = 70%). AT recurrence (RR = 0.92, 95% CI = 0.67-1.27, p = .63, I = 42%) and adverse events (RR = 1.11, 95% CI = 0.67-1.84, p = .70, I = 0%) were comparable between the two groups. In the sub-analyses, the efficacy of PWI in reducing AA recurrence was consistent in patients who underwent cryoablation or debulking ablation.
PWI effectively decreased AA recurrence after PerAF ablation without increasing the risk of AT or procedure-related complications. However, more randomized studies are needed to confirm these results.
单纯肺静脉隔离治疗持续性心房颤动（PerAF）的临床结局尚不清楚。辅助性后壁隔离（PWI）已成为改善PerAF消融结局的一种潜在补充策略。本荟萃分析旨在评估PWI加用至导管消融治疗PerAF的效果。
检索PubMed、EMBASE和Cochrane图书馆数据库，查找比较有或无PWI的PerAF消融结局的研究。疗效结局为房性心律失常（AA）、心房颤动（AF）和房性心动过速（AT）的复发，安全性结局为不良事件。
汇总分析共纳入8项研究1428例患者。结果显示，PWI显著降低了AA的复发率（RR = 0.69，95%CI = 0.55 - 0.87，p = 0.002，I² = 63%）和AF的复发率（RR = 0.57，95%CI = 0.40 - 0.80，p = 0.001，I² = 70%）。两组间AT复发率（RR = 0.92，95%CI = 0.67 - 1.27，p = 0.63，I² = 42%）和不良事件发生率（RR = 1.11，95%CI = 0.67 - 1.84，p = 0.70，I² = 0%）相当。亚组分析中，PWI在接受冷冻消融或减容消融的患者中降低AA复发的疗效一致。
PWI有效降低了PerAF消融术后AA的复发率，且未增加AT或手术相关并发症的风险。然而，需要更多随机研究来证实这些结果。
