心外科手术同期行房颤射频消融术的有效性及安全性：meta分析

Efficacy and safety of surgical radiofrequency ablation for atrial fibrillation during cardiac surgery： a meta-analysis

目的应用meta分析评价心脏病变合并心房颤动（房颤）患者外科手术同期行射频消融术的临床有效性及安全性。方法计算机检索PubMed，Embase，Cochrane图书馆，中国学术期刊全文数据库（CNKI）、中国生物医学文献数据光盘数据库（CBMdisc）及维普数据库（VIP），比较心脏外科同期行与未行外科消融术的随机对照研究。文献检索时间从建库至2014年11月。风险偏倚表评价纳入文献的质量并提取资料。对符合质量标准的对照研究采用RevMan5．2进行异质性检验及meta分析。结果检出相关文献564篇，根据纳入标准最终入选8篇，人选病例591例。按手术方式分为外科射频消融手术（RFA）组342例，单纯外科（SA）组249例。有效性方面，RFA组术后窦性心律转复率明显高于sA组（OR=10．59；95％CI：3．81～29．45），差异有统计学意义（P〈0．01）；随访6个月、1年及〉1年时维持窦性心律患者比例高于SA组（分别P〈0．01；P〈0．01；P=0．02）。安全性方面，两组在术后住院病死率（OR=1．17；95％CI：0．41～3．35）、术后随访期病死率（OR=0．77；95％CI：0．35～1．69）上差异无统计学意义（分别P=0．76；P=0．52）。两组在术后置入起搏器（OR=0．65；95％CI：0．28～1．52；P=0．32）、术后血栓事件（OR=1．61；95％CI：0．544．84；P=0．40）、因出血再干预（OR=0．45；95％CI：0．12～1．70；P=0．24）的发生比例差异均无统计学意义。结论心外科手术同期行射频消融术可有效维持心脏病变合并房颤患者的窦性心律，有效性和安全性良好。

Objective The purpose of this sturdy was to conduct a meta-analysis of published randomised controlled trials （RCT） comparing the clinical outcomes of radiofrequency ablation（RFA） versus surgery alone（SA） in all patients with cardiac surgery. Methods PubMed, Embase, the Coehrane Controlled Trials Register databases, CNKI, CBM disc and VIP datebases were searched, and study eligibility and conducted data abstraction were determined independently and in duplicate. Literature searches from database establishment to November 2014. The heterogeneity and data were analyzed by the software of Rev Man 5.2. Results Of 56d studies identified, 8 studies met eligibility criteria, and included a total of 591 patients. In efficacy, The number of patients in sinus rhythm（SR） was signifcantly improved in RFA group compared to SA group at discharge（OR = 10.59 ;95% CI： 3.81-29.45）. This effect on SR remained at all follow-up periods until 〉 1 year. In safety, there was no significant difference in the incidence of hospital mortality（ OR = 1.17 ; 95% CI： 0. 41-3.35 ） and mortality rate in follow up period （ OR = 0.77 ; 95 % CI： 0.35-1.69 ） between RFA group and SA group. Similar results were shown in the incidence of permanent pacemaker（ OR = 0. 65; 95 % CI： 0.28-1.52;P = 0.32） , thromboembolie events （ OR = 1.61 ; 95% CI： 0.54-4.84 ; P = 0.40 ） , postoperative re-intervention for bleeding （ OR = O. 45 ; 95 % CI： 0.12-1.70 ; P = 0.24 ）. Conclusion The results of the current randomized trials demonstrates that concomitant surgical radiofrequency ablation and cardiac surgery is safe and effective at restoring sinus rhythm.