Tang Wei, Liu Menghui, Li Jie, Chang Rongxuan, Su Chen, Zhang Xiaoyu, Wang Lichun
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, China.
Department of Medicine College, Sun Yat-sen University, 510080 Guangzhou, Guangdong, China.
Rev Cardiovasc Med. 2022 Nov 30;23(12):391. doi: 10.31083/j.rcm2312391. eCollection 2022 Dec.
Alcohol septal ablation (ASA) has been more commonly applied in medical refractory hypertrophic obstructive cardiomyopathy (HOCM) compared with septal myectomy (SM), however its potential to create a proarrhythmic substrate is increased.
A systematic search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to October 2020. Fixed or random effects models were used to estimate the risk ratios (RR) for ventricular arrhythmia events or other outcomes between the SM and ASA cohorts.
Twenty studies with 8025 patients were included. Pool analysis showed that the incidence of ventricular tachycardia (VT)/ventricular fibrillation (VF), which included appropriate implantable cardioverter defibrillator (ICD) intervention, was significantly higher in the ASA cohort than that in the SM cohort (ASA SM: 10% (345/3312) 5% (161/3227) (RR = 1.98, 95% CI (confidence interval), 1.65-2.37; 0.00001, = 0%). In both groups, more than 90% of VT/VF events occurred in the early phase (during the procedure, during hospitalization or within 30 days after the procedure) (ASA: 94.20%; SM: 94.41%). Further subgroup analysis also showed that the ASA group had a higher incidence of VT/VF in both the early phase (RR = 1.94, 95% CI, 1.61-2.33; 0.0001, = 0%) and the late phase (RR = 2.80, 95% CI, 1.00-7.89; = 0.05, = 33%). Furthermore, although the risks of sudden cardiac death (SCD) were similar between the ASA and SM groups, a higher incidence of sudden cardiac arrest (SCA), which included SCD and resuscitated SCA, was observed in the ASA group (RR = 2.30, 95% CI, 1.35-3.94; = 0.002, = 0%).
In patients with HOCM, those who received ASA showed a higher incidence of VF/VT and SCD combined with resuscitated SCA. The majority of VT/VF occurred in the early phase.
与室间隔心肌切除术（SM）相比，酒精间隔消融术（ASA）在药物难治性肥厚性梗阻性心肌病（HOCM）中的应用更为普遍，但其产生致心律失常基质的可能性增加。
从创刊至2020年10月在PubMed、EMBASE、科学网和Cochrane图书馆进行了系统检索。采用固定或随机效应模型估计SM组和ASA组之间室性心律失常事件或其他结局的风险比（RR）。
纳入20项研究，共8025例患者。汇总分析显示，ASA组室性心动过速（VT）/室性颤动（VF）（包括适当的植入式心脏复律除颤器（ICD）干预）的发生率显著高于SM组（ASA组对SM组：10%（345/3312）对5%（161/3227）（RR = 1.98，95%置信区间（CI），1.65 - 2.37；P < 0.00001，I² = 0%）。在两组中，超过90%的VT/VF事件发生在早期阶段（手术期间、住院期间或手术后30天内）（ASA组：94.20%；SM组：94.41%）。进一步的亚组分析还显示，ASA组在早期阶段（RR = 1.94，95% CI，1.61 - 2.33；P < 0.0001，I² = 0%）和晚期阶段（RR = 2.80，95% CI，1.00 - 7.89；P = 0.05，I² = 33%）的VT/VF发生率均较高。此外，虽然ASA组和SM组的心源性猝死（SCD）风险相似，但ASA组观察到的心搏骤停（SCA）（包括SCD和复苏的SCA）发生率较高（RR = 2.30，95% CI，1.35 - 3.94；P = 0.002，I² = 0%）。
在HOCM患者中，接受ASA治疗的患者VF/VT以及SCD合并复苏的SCA发生率较高。大多数VT/VF发生在早期阶段。
