Providencia Rui, Ali Hussam, Creta Antonio, Barra Sérgio, Kanagaratnam Prapa, Schilling Richard J, Farkowski Michal, Cappato Riccardo
Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHST Trust, W Smithfield, London EC1A 7BE, UK.
Eur Heart J Open. 2024 Jul 15;4(4):oeae058. doi: 10.1093/ehjopen/oeae058. eCollection 2024 Jul.
Catheter ablation is the most effective rhythm-control option in patients with atrial fibrillation (AF) and is currently considered an option mainly for improving symptoms. We aimed to assess the impact of catheter ablation on hard clinical outcomes.
We performed a systematic review of randomized controlled trials (RCTs) comparing catheter ablation vs. optimized medical treatment. We searched MEDLINE, EMBASE, and CENTRAL on 8 January 2024, for trials published ≤10 years. We pooled data through risk ratio (RR) and mean differences (MDs), with 95% confidence interval (CI), and calculated the number needed to treat (NNT). Sub-group and sensitivity analyses were performed for the presence/absence of heart failure (HF), paroxysmal/persistent AF, early ablation, higher/lower quality, and published ≤5 vs. >5 years. Twenty-two RCTs were identified, including 6400 patients followed for 6-52 months. All primary endpoints were significantly reduced by catheter ablation vs. medical management: all-cause hospitalization (RR = 0.57, 95% CI 0.39-0.85, = 0.006), AF relapse (RR = 0.48, 95% CI 0.39-0.58, < 0.00001), and all-cause mortality (RR = 0.69, 95% CI 0.56-0.86, = 0.0007, NNT = 44.7, driven by trials with HF patients). A benefit was also demonstrated for all secondary endpoints: cardiovascular mortality (RR = 0.55, 95% CI 0.34-0.87), cardiovascular (RR = 0.83, 95% CI 0.71-0.96), and HF hospitalizations (RR = 0.71, 95% CI 0.56-0.89), AF burden (MD = 20.6%, 95% CI 5.6-35.5), left ventricular ejection fraction (LVEF) recovery (MD = 5.7%, 95% CI 3.5-7.9), and quality of life (MLHFQ, AFEQT, and SF-36 scales).
Catheter ablation significantly reduced hospitalizations, AF burden, and relapse, and improved quality of life. An impact on hard clinical outcomes, with an important mortality reduction and improvement in LVEF, was seen for patients with AF and HF.
导管消融是心房颤动（AF）患者最有效的节律控制选择，目前主要被视为改善症状的一种选择。我们旨在评估导管消融对硬性临床结局的影响。
我们对比较导管消融与优化药物治疗的随机对照试验（RCT）进行了系统评价。我们于2024年1月8日在MEDLINE、EMBASE和CENTRAL数据库中检索了发表时间≤10年的试验。我们通过风险比（RR）和均值差（MD）汇总数据，并给出95%置信区间（CI），同时计算治疗所需人数（NNT）。针对是否存在心力衰竭（HF）、阵发性/持续性AF、早期消融、高质量/低质量以及发表时间≤5年与>5年进行了亚组分析和敏感性分析。共纳入22项RCT，包括6400例患者，随访时间为6至52个月。与药物治疗相比，导管消融显著降低了所有主要终点：全因住院率（RR = 0.57，95% CI 0.39 - 0.85，P = 0.006）、AF复发率（RR = 0.48，95% CI 0.39 - 0.58，P < 0.00001）以及全因死亡率（RR = 0.69，95% CI 0.56 - 0.86，P = 0.0007，NNT = 44.7，由HF患者的试验驱动）。对于所有次要终点也显示出益处：心血管死亡率（RR = 0.55，95% CI 0.34 - 0.87）、心血管（RR = 0.83，95% CI 0.71 - 0.96）以及HF住院率（RR = 0.71，95% CI 从0.56至0.89）、AF负荷（MD = 20.6%，95% CI 5.6 - 35.5）、左心室射血分数（LVEF）恢复（MD = 5.7%，95% CI 3.5 - 7.9）以及生活质量（MLHFQ、AFEQT和SF - 36量表）。
导管消融显著降低了住院率、AF负荷和复发率，并改善了生活质量。对于AF合并HF的患者，导管消融对硬性临床结局有影响，显著降低了死亡率并改善了LVEF。
