肺静脉隔离在房颤患者中维持窦性节律的系统评价

Systematic review and Meta-analysis of the efficacy of pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation

目的系统评价使用肺静脉隔离(PVI)的导管消融治疗方法对房颤患者维持窦性节律的效果。方法检索PubMed、CENTRAL、EMbase、NTIS、CNKI、VIP、万方数据库和CBM中所有对比PVI和抗心律失常药物(ADD)治疗维持房颤患者窦性心律的临床随机对照试验(RCT),同时追索纳入文献的参考文献。检索时限均为从建库至2013年2月。对符合质量标准的RCT进行系统评价和Meta分析。结果共纳入9个随机对照试验。Meta分析主要和次要终点的结果显示:在1年的随访期时,PVI的有效性显著[77%(466/631)比38%(227/590),OR=5.93,95%CI 4.52～7.80,P<0.01],GRADE系统推荐分级为中级。PVI可显著降低因心血管事件导致的住院率(5%比24%,RR=0.15,95%CI 0.06～0.36,P<0.01),GRADE系统推荐分级为高级。在PVI组,严重并发症的发生率是2.7%(17/631)。结论与ADD治疗策略相比,PVI显著增加1年期的窦律维持率,显著减少因心血管疾病原因导致的再住院率,而并发症的发生率甚至低于其他介入治疗。

Objective To evaluate pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation. Methods PubMed, CENTRAL, Embase, NTIS, CNKI, VIP, Wanfang Data and CBM were search for all randomized, controlled trials comparing PVI and medical therapy for the maintenance of sinus rhythm in patients with atrial fibrillation from the date of establishment of the databases to December 2012. The bibliographies of the include studies were searched too. Systematic review and Meta-analysis were conducted for the eligible RCTs. Results 9 trials were discovered. Meta-analyses show that PVI was associated with markedly increased odds of freedom from AF at 1 year of follow-up [77% （466/631） vs 38% （227/590）, OR=5.93, 95% CI 4.52-7.80, P 〈 0.01], it was moderate grade in the GRADE system. PVI was associated with a decreased hospitalization for cardiovascular causes （5% vs 24%, RR = 0.15, 95%CI 0.06-0.36, P 〈 0.01）, it Was high grade in the GRADE system. The rate of major complications was 2.7% （17/631） in the catheter ablation group. Conclusion Compared with ADD treatmentstrategy, PVI results in dra- matically increased freedom from AF and decreased hospitalization for cardiovascular causes at 1 year, the risk of these complications is lower than other interventional procedures.