From the Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Health, Herston, QLD, Australia.
Cardiol Rev. 2024;32(2):162-169. doi: 10.1097/CRD.0000000000000493. Epub 2022 Dec 20.
Atrial fibrillation (AF) is a prevalent problem worldwide and a common cause of hospitalization, poor quality of life, and increased mortality. Although several treatments are used, the use of ablation and antiarrhythmic drug therapy has increased in the past decade. However, debate continues on the most suitable option for heart rhythm control in patients. Previous studies have largely focused on short-term outcome effects of these treatments. This systematic review aims to determine the effect of ablation compared to antiarrhythmic drugs for AF on long-term patient and health service outcomes of mortality, hospitalization, and quality of life. Three databases were systematically searched-studies were included if they reported long-term outcomes of more than 12 months comparing the 2 treatments. Title and abstract screening and subsequent full-text screening was done by 2 reviewers. Data were extracted from the final studies identified. The details of the search were recorded according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses report. A total of 2224 records were identified. After removing duplicates and screening the titles and abstracts, 68 records required full-text screening. Finally, 12 papers were included in the analysis. Eight studies reported mortality indicating ablation was superior, 2 studies reported hospitalization with opposing outcomes, and 5 quality of life studies indicating ablation was a better treatment. In studies assessing long-term outcomes, beyond 12 months, following ablation or rhythm control drugs for AF, most found a lower risk of death and greater improvement in quality of life in the ablation group.
心房颤动（AF）是全球普遍存在的问题，也是住院、生活质量下降和死亡率增加的常见原因。尽管有几种治疗方法，但在过去十年中，消融和抗心律失常药物治疗的使用有所增加。然而，对于 AF 患者的心律控制，哪种治疗方法最合适仍存在争议。以前的研究主要集中在这些治疗方法的短期效果上。本系统评价旨在确定消融与抗心律失常药物治疗 AF 在死亡率、住院率和生活质量的长期患者和卫生服务结果方面的效果。系统地搜索了三个数据库——如果研究报告了超过 12 个月的两种治疗方法的长期结果，则将其纳入研究。由两名评审员进行标题和摘要筛选以及随后的全文筛选。从最终确定的研究中提取数据。根据系统评价和荟萃分析报告的首选报告项目详细记录了搜索的详细信息。共确定了 2224 条记录。在去除重复项并筛选标题和摘要后，有 68 篇记录需要全文筛选。最后，有 12 篇论文纳入分析。八项研究报告了死亡率，表明消融效果更好，两项研究报告了住院情况，结果相反，五项生活质量研究表明消融是更好的治疗方法。在评估 AF 消融或节律控制药物治疗 12 个月以上的长期结果的研究中，大多数研究发现消融组的死亡风险较低，生活质量改善更大。
