神经节消融治疗房颤的荟萃分析

Ganglionated plexi ablation for atrial fi brillation: A meta-analysis

目的 研究肺静脉电隔离（pulmonary vein isolation,PVI）或迷宫手术（maze procedure,MAZE）联合神经节消融,和单独神经节消融治疗房颤的疗效.方法 在PubMed、Embase、Cochrane、ClinicalTrials、Sinomed以及万方数据库中进行了系统的文献检索（1968年-2013年6月）,纳入了PVI/MAZE联合神经节消融与传统PVI/MAZE的比较,单独神经节消融与PVI/MAZE的比较的对照试验文献.主要结局终点是单次手术后未服用抗心律失常药物无颤或房速复发的成功率.检索的303篇文献中有7篇入选.结果 PVI/MAZE联合神经节消融显著提高了阵发性房颤患者窦性心律的维持（n=395,OR 6.94;95％ CI：2.97 ～ 16.21）,而对于非阵发房颤的患者则无明显获益（n=174,OR 2.84;95％ CI：0.81～10.03）.单独神经节消融术后窦性心律维持率低于PVI/MAZE（n=106,OR 0.31;95％ CI：0.14～ 0.71）.结论 PVI/MAZE联合神经节消融可提高阵发性房颤患者窦性心律的维持率,但非阵发性房颤患者无明显获益;单独神经节消融成功率低于PVI.

Objective To study the therapeutic effect of pulmonary vein isolation （PVI） or combined maze and ganglionic plexi （GP） ablation or GP ablation alone on atrial fibrillation （AF）.Methods Papers on PVI/MAZE combined with GP ablation,traditional PVI/MAZE,GP ablation alone were retrieved from PubMed,EMBase,Cochrane controlled trials register （CCRT）,ClinicalTrials,Sinomed,and WanFang from 1968 to June 2013.The main end-points were the AF-free or antiarrhythmic drug-free AF success rate of a single operation.Of the 303 papers retrieved,7 were included in this study.Results PVI/MAZE combined with GP ablation significantly improved the sinus rhythm in paroxysmal AF patients （n=395,OR=6.94,95% CI：2.97-16.21） and had no significant effect on the sinus rhythm in non-paroxysmal AF patients （n=174,OR=2.84,95% CI：0.81-10.03）.The sinus rhythm was lower in paroxysmal and non-paroxysmal AF patients after GP ablation alone than after PVI/MAZE （n=106,OR=0.31,95% CI：0.14-0.71）.Conclusion PVI/MAZE combined with GP ablation can significantly improve the sinus rhythm in paroxysmal AF patients and has no significant effect on the sinus rhythm in non-paroxysmal AF patients.The success rate of GP ablation alone is lower than that of PVI.