He Changjian, Zhang Wenchang, Li Feng, Wang Huaiqiang, Han Xiongyi, Zhao Zihan, Ye Guojie, Liu Tengfei, Zhang Da, Liu Haiyan, Liu Jie, Zhao Jingning, Ding Chunhua
Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), 100049 Beijing, China.
Department of Cardiology, The Second Affiliated Hospital of Soochow University, 215004 Suzhou, Jiangsu, China.
Rev Cardiovasc Med. 2025 Jul 30;26(7):33419. doi: 10.31083/RCM33419. eCollection 2025 Jul.
The optimal endpoint for ablation in persistent atrial fibrillation (pers-AF) remains unclear. This study aimed to systematically evaluate the prognostic value of acute AF termination in predicting the recurrence of arrhythmias.
A systematic search of the PubMed, Cochrane Library, Web of Science, and Embase databases was conducted from inception to July 2023. Only studies with reports of acute termination for pers-AF and its predictive role in arrhythmia recurrence were included. Subgroup analysis was performed to identify potential confounders for the effect of AF termination.
A total of 22 studies were included in the meta-analysis. The pooled analysis indicated that acute termination of AF is significantly associated with an increased long-term success rate (relative risk (RR), 1.53; 95% CI, 1.41-1.66; < 0.001; I = 35.4%). Moreover, subgroup analysis revealed that patients with an AF duration >12 months (RR, 1.92; 95% CI, 1.57-2.35; < 0.001), aged >60 years (RR, 1.92; 95% CI, 1.60-2.31; < 0.001) may derive benefits from AF termination during ablation. Interestingly, a significant interaction was observed in the study design subgroup, where multi-center studies showed a success rate of RR, 1.31 (95% CI, 1.14-1.50; < 0.001), while single-center studies exhibited a higher success rate of RR, 1.65 (95% CI, 1.49-1.82; < 0.001), with an interaction -value of 0.008. Importantly, acute termination of AF did not significantly increase procedural complications (RR, 1.19; 95% CI, 0.59-2.39; = 0.627; I = 0.0%).
Our study suggests that AF acute termination during ablation for pers-AF provides a better long-term clinical outcome.
CRD42023431015, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023431015.
持续性心房颤动（pers-AF）消融的最佳终点仍不明确。本研究旨在系统评估急性房颤终止对预测心律失常复发的预后价值。
从数据库建立至2023年7月，对PubMed、Cochrane图书馆、Web of Science和Embase数据库进行系统检索。仅纳入报告了pers-AF急性终止情况及其对心律失常复发预测作用的研究。进行亚组分析以确定房颤终止效果的潜在混杂因素。
荟萃分析共纳入22项研究。汇总分析表明，房颤急性终止与长期成功率增加显著相关（相对风险（RR）为1.53；95%置信区间为1.41 - 1.66；P < 0.001；I² = 35.4%）。此外，亚组分析显示，房颤持续时间>12个月的患者（RR为1.92；95%置信区间为1.57 - 2.35；P < 0.001）、年龄>60岁的患者（RR为1.92；95%置信区间为1.60 - 2.31；P < 0.001）在消融过程中房颤终止可能获益。有趣的是，在研究设计亚组中观察到显著交互作用，多中心研究的成功率RR为1.31（95%置信区间为1.14 - 1.50；P < 0.001），而单中心研究的成功率RR更高，为1.65（95%置信区间为1.49 - 1.82；P < 0.001），交互作用P值为0.008。重要的是，房颤急性终止并未显著增加手术并发症（RR为1.19；95%置信区间为0.59 - 2.39；P = 0.627；I² = 0.0%）。
我们的研究表明，pers-AF消融过程中的房颤急性终止可提供更好的长期临床结局。
PROSPERO注册号：CRD42023431015，https://www.crd.york.ac.uk/PROSPERO/view/CRD42023431015
