磁导航指导下室性心动过速导管消融与手动导管消融比较的荟萃分析

Remote magnetic navigation vs. manual navigation for ablation of ventricular tachycardia：a meta-analy-sis

目的：探讨磁导航指导下室性心动过速（ VT）导管消融的疗效和安全性。方法检索PubMed、EMBASE、Cochrane Library文献数据库,检索时间为建库之日起至2013年12月31日,内容为关于磁导航指导下VT导管消融（ RMN）与手动导管消融（ MCN）的文献,比较2种消融方式下即刻成功率、复发率、并发症发生率、手术时间及曝光时间等相关数据并进行荟萃分析。结果经检索有4篇文献纳入,共328例患者,RMN组与MCN组分别为191例和137例。两组即刻成功率为89．5%和72．3%（OR 1．845,95% CI 0．731∽4．659,P=0．195）,远期复发率为25．5%和35．2%（OR 0．676,95% CI 0．383∽1．194,P=0．177）,差异无统计学意义；RMN组和MCN组并发症发生率为2．9%和12．0%（OR 0．279,95% CI 0．092∽0．843,P=0．024）,平均手术时间为165．1 min和185．2 min（95% CI -0．487∽-0．035,P=0．024）,平均曝光时间为21．6 min和41．9 min（95% CI -1．467∽-0．984,P〈0．001）,RMN组均较MCN组缩短。结论与手动导管消融相比,磁导航指导下VT导管消融更安全有效。

Objective The purpose of this study was to evaluate the efficacy and safety of the remote magnetic navigation （ RMN ） in comparison with manual catheter navigation （ MCN ） in performing ventricular tachycardia（VT） ablation. Methods An electronic search was performed using PubMed,EMBASE,and Co-chrane Library studies comparing RMN with MCN which published prior to 31 December 2013. Outcomes of inter-est were as follows：acute success,recurrence rate,complications,total procedure and fluoroscopic times. Standard mean difference（ SMD） and its 95% CI were used for continuous outcomes;odds ratios（ OR） were reported for di-chotomous variables. Results Four non-randomized studies,including 328 patients,were identified. RMN was de-ployed in 191 patients. Acute success and long-term freedom from arrhythmias were not significantly different be-tween RMN and control groups（OR 1. 845,95% CI 0. 731 were 4. 659,P=0. 195 and OR 0. 676,95% CI 0. 383 were 1. 194,P=0. 177,respectively）. RMN was associated with less peri-procedural complications（OR 0. 279, 95% CI 0. 092 were 0. 843,P=0. 024）. A shorter procedural and fluoroscopy times were achieved（-20. 1 min, 95% CI -0. 487 were -0. 035,P=0. 024,and -20. 3 min,95% CI -1. 467 were -0. 984,P〈0. 001,respective-ly） . Conclusion The acute and long-term success rates for VT ablation were equal between RMN and MCN, whereas RMN-guided procedure can be performed with a lower complication rate and less procedural and fluoro-scopic times. More prospective randomized trials will be needed to evaluate the superior role of RMN for catheter ablation of VT.