房颤的导管消融与神经疾病风险
Catheter ablation for atrial fibrillation and risk of neurologic disease.
作者信息
Al-Sadawi Mohammed, Tokavanich Nithi, Devgun Jasneet, Ghannam Michael, Latchamsetty Rakesh, Jongsarangsin Krit, Oral Hakan
机构信息
Clinical Cardiac Electrophysiology Department, University of Michigan Hospital, Ann Arbor, Michigan.
出版信息
Heart Rhythm O2. 2024 Nov 9;6(1):32-38. doi: 10.1016/j.hroo.2024.11.004. eCollection 2025 Jan.
BACKGROUND
Catheter ablation (CA) of atrial fibrillation (AF) has been proven to benefit patients with symptomatic AF and heart failure. However, the data on neurological outcomes including cerebrovascular accidents (CVA) and dementia remain controversial.
OBJECTIVE
We aimed to determine the effect of CA on neurological events during long-term follow-up.
METHODS
We performed a systematic review and meta-analysis of patients with AF who underwent CA of AF. The MEDLINE, EMBASE, and Web of Science databases were comprehensively searched from inception to January 2024. Studies that reported incidence of CVA and dementia in patients with AF were. Data from each study were combined by a random-effects model. The results were reported in risk ratios with 95% confidence intervals (CIs).
RESULTS
A total of 29 studies and 379,993 patients (mean age 58 ± 4 years, 30% women) were included in the analysis. Mean follow-up was 36 ± 23 months (range 12-120 months). Patients who underwent CA of AF had a lower risk of developing CVA compared with medical management (odds ratio [OR] 0.54, 95% CI 0.42-0 69, I = 91%). Moreover, the risk of dementia was lower in the CA group compared with medical management (OR 0.51, 95% CI 0.4-0.66, I = 74%). The incidence of CVA in the CA group was 1% (95% CI 1%-2%, I = 97%), and the incidence of dementia was 2% (95% CI 2%-8%, I = 97%).
CONCLUSION
CA of AF resulted in lower risk of CVA and dementia compared with medical management alone at long-term follow-up.
背景
心房颤动（AF）的导管消融术（CA）已被证明对有症状的AF和心力衰竭患者有益。然而，包括脑血管意外（CVA）和痴呆症在内的神经学结局数据仍存在争议。
目的
我们旨在确定CA在长期随访期间对神经学事件的影响。
方法
我们对接受AF导管消融术的AF患者进行了系统评价和荟萃分析。从数据库建立至2024年1月，全面检索了MEDLINE、EMBASE和Web of Science数据库。纳入报告AF患者CVA和痴呆症发病率的研究。每项研究的数据采用随机效应模型进行合并。结果以风险比及95%置信区间（CI）报告。
结果
分析共纳入29项研究和379,993例患者（平均年龄58±4岁，30%为女性）。平均随访时间为36±23个月（范围12 - 120个月）。与药物治疗相比，接受AF导管消融术的患者发生CVA的风险更低（优势比[OR] 0.54，95% CI 0.42 - 0.69，I² = 91%）。此外，与药物治疗相比，CA组发生痴呆症的风险更低（OR 0.51，95% CI 0.4 - 0.66，I² = 74%）。CA组CVA的发生率为1%（95% CI 1% - 2%，I² = 97%），痴呆症的发生率为2%（95% CI 2% - 8%，I² = 97%）。
结论
在长期随访中，与单纯药物治疗相比，AF导管消融术导致CVA和痴呆症的风险更低。
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