Li Yang, Xi Yin, Zhang Wenyu, Hao Jie
Department of Cardiology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei, China.
Rev Cardiovasc Med. 2024 Sep 6;25(9):316. doi: 10.31083/j.rcm2509316. eCollection 2024 Sep.
Circumferential pulmonary vein isolation (CPVI) has a high recurrence rate in managing persistent atrial fibrillation (AF). While some studies suggest that augmenting CPVI with additional left atrial BOX ablation can diminish this recurrence rate among patients with persistent AF, this approach remains controversial. This meta-analysis assesses the safety and efficacy of adjunctive left atrial BOX ablation in treating persistent atrial fibrillation.
We conducted a comprehensive literature search across China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and Cochrane Library, focusing on randomized controlled trials. The primary outcome was the recurrence rate of any atrial arrhythmias (AAs) within one-year post-treatment, with the secondary outcome being the frequency of adverse events related to the surgery.
The combination of CPVI and left atrial BOX ablation did not lead to a significant reduction in the overall recurrence rate of atrial arrhythmias (risk ratios (RR) = 0.86, 95% confidence interval (CI) = 0.73-1.02, I = 35%). However, subgroup analyses revealed that this therapeutic approach significantly decreased the recurrence rates of all atrial arrhythmias (RR = 0.67, 95% CI = 0.49-0.92, I = 15%) and specifically atrial fibrillation (RR = 0.53, 95% CI = 0.37-0.77, I = 0%) in patients with a left atrial diameter ≤44 mm. Notably, there was no significant increase in the incidence of procedure-related adverse events (RR = 1.04, 95% CI = 0.56-1.94, I = 0%). However, the durations of both the ablation (mean difference (MD) = 19.77, 95% CI = 15.84-23.70, I = 0%) and the overall procedure (MD = 15.64, 95% CI = 6.99-24.29, I = 0%) were longer due to the additional ablation steps.
In patients with smaller left atrial diameters, augmenting CPVI with left atrial BOX ablation significantly lowers the recurrence rates of atrial arrhythmias and atrial fibrillation without elevating surgical risk levels.
环肺静脉隔离术（CPVI）治疗持续性心房颤动（AF）的复发率较高。虽然一些研究表明，附加左心房线性消融术可降低持续性AF患者的复发率，但这种方法仍存在争议。本荟萃分析评估了附加左心房线性消融术治疗持续性心房颤动的安全性和有效性。
我们在中国知网、PubMed、Web of Science和Cochrane图书馆进行了全面的文献检索，重点关注随机对照试验。主要结局是治疗后1年内任何房性心律失常（AA）的复发率，次要结局是与手术相关的不良事件发生频率。
CPVI联合左心房线性消融术并未显著降低房性心律失常的总体复发率（风险比（RR）=0.86，95%置信区间（CI）=0.73-1.02，I²=35%）。然而，亚组分析显示，这种治疗方法显著降低了左心房直径≤44mm患者的所有房性心律失常复发率（RR=0.67，95%CI=0.49-0.92，I²=15%），尤其是心房颤动复发率（RR=0.53，95%CI=0.37-0.77，I²=0%）。值得注意的是，与手术相关的不良事件发生率没有显著增加（RR=1.04，95%CI=0.56-1.94，I²=0%）。然而，由于额外的消融步骤，消融时间（平均差（MD）=19.77，95%CI=15.84-23.70，I²=0%）和整个手术时间（MD=15.64，95%CI=6.99-24.29，I²=0%）均延长。
对于左心房直径较小的患者，CPVI联合左心房线性消融术可显著降低房性心律失常和心房颤动的复发率，且不增加手术风险。
