导管消融术与药物治疗对心力衰竭房颤患者的疗效比较：随机对照试验的最新荟萃分析
Catheter ablation vs. drug therapy in the treatment of atrial fibrillation patients with heart failure: An update meta-analysis for randomized controlled trials.
作者信息
Lin Chun, Sun Mingyan, Liu Youbin, Su Yongkang, Liang Xiao, Ma Shouyuan, Zhu Ping, Fu Yuming, Liu Jianfeng
机构信息
Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of General Medicine and Geriatrics, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China.
出版信息
Front Cardiovasc Med. 2023 Mar 8;10:1103567. doi: 10.3389/fcvm.2023.1103567. eCollection 2023.
BACKGROUND
Atrial fibrillation (AF) and heart failure (HF) often coexist. The treatment of AF in patients with HF has been challenging because of the ongoing debate about the merits of catheter ablation vs. drug therapy.
METHODS
The Cochrane Library, PubMed, and www.clinicaltrials.gov were searched until June 14, 2022. Inclusion criteria were catheter ablation compared with drug therapy in adults with AF and HF in randomized controlled trials (RCTs). Primary outcomes consisted of all-cause mortality, re-hospitalization, change in left ventricular ejection fraction (LVEF), and AF recurrence. Secondary outcomes referred to quality of life [QoL; measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ)], six-minute walk distance (6MWD), and adverse events. The PROSPERO registration ID was CRD42022344208.
FINDINGS
In total, nine RCTs with 2,100 patients met the inclusion criteria, with 1,062 for catheter ablation and 1,038 for medication. According to the meta-analysis, catheter ablation significantly reduced all-cause mortality compared with drug therapy [9.2% vs. 14.1%, OR: 0.62, (95% CI: 0.47-0.82), = 0.0007, = 0%], improved LVEF [MD: 5.65%, (95% CI: 3.32-7.98), 0.00001, = 86%], reduced AF recurrence [41.6% vs. 61.9%, OR: 0.23, (95% CI: 0.11-0.48), 0.0001, = 82%], decreased the MLHFQ score [MD: -6.38, (95% CI: -11.09 to -1.67), = 0.008, = 64%] and increased 6MWD [MD: 17.55, (95% CI: 15.77-19.33), 0.0001, = 37%]. Catheter ablation did not increase the re-hospitalization [30.4% vs. 35.5%, OR: 0.68, (95% CI: 0.42-1.10), = 0.12, = 73%] and adverse events [31.5% vs. 30.9%, OR: 1.06, (95% CI: 0.83-1.35), = 0.66, = 48%].
INTERPRETATION
In AF patients with HF, catheter ablation improves exercise tolerance, QoL, and LVEF and significantly reduced all-cause mortality and AF recurrence. Although the differences were not statistically significant, the study found lower re-hospitalization and approximate adverse events with improved catheter ablation tendency.
PROSPERO REGISTRATION ID
CRD42022344208.
背景
心房颤动（AF）与心力衰竭（HF）常并存。由于关于导管消融与药物治疗的优缺点存在持续争论，HF患者的AF治疗一直具有挑战性。
方法
结果
共有9项RCT（2100例患者）符合纳入标准，其中1062例接受导管消融，1038例接受药物治疗。根据荟萃分析，与药物治疗相比，导管消融显著降低全因死亡率[9.2%对14.1%，OR：0.62，（95%CI：0.47 - 0.82），P = 0.0007，I² = 0%]，改善LVEF[MD：5.65%，（95%CI：3.32 - 7.98），P = 0.00001，I² = 86%]，降低AF复发率[41.6%对61.9%，OR：0.23，（95%CI：0.11 - 0.48），P =0.0001，I² = 82%]，降低MLHFQ评分[MD： - 6.38，（95%CI： - 11.09至 - 1.67），P = 0.008，I² = 64%]并增加6MWD[MD：17.55，（95%CI：15.77 - 19.33），P = 0.0001，I² = 37%]。导管消融未增加再住院率[30.4%对35.5%，OR：0.68，（95%CI：0.42 - 1.10），P = 0.12，I² = 73%]和不良事件[31.5%对30.9%，OR：1.06，（95%CI：0.83 - 1.35），P = 0.66，I² = 48%]。
解读
在AF合并HF患者中，导管消融可改善运动耐量、QoL和LVEF，并显著降低全因死亡率和AF复发率。尽管差异无统计学意义，但研究发现导管消融有降低再住院率和不良事件的趋势，且不良事件相近。
PROSPERO注册号：CRD42022344208。
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