联合埋藏式心律转复除颤仪及射频消融治疗室性心律失常有效性的荟萃分析

Implantable cardioverter-defibrillator and catheter ablation for patients with ventricular arrhythmia:a meta analysis

目的:对已发表的随机对照研究以及队列研究进行荟萃分析,验证联合植入埋藏式心律转复除颤仪(implantable cardioverter-defibrillator,ICD)及射频消融的治疗方法是否有效。方法:使用MEDLINE及EMBASE搜索引擎搜索相关临床研究文献,时间截止至2018年12月21日。对搜索到的文献浏览其引用文献列表以防止遗漏。文献入选标准为报告了ICD风暴、ICD电击次数、ICD事件、室性心律失常复发率、每月ICD治疗次数等终点的随机对照研究和队列研究。荟萃分析的合并效应量采用随机效应模型。结果:共有12项研究被纳入本荟萃分析。纳入的总病例数为667例。与单纯植入ICD组相比,ICD植入联合射频消融组的终点事件风险更低。各终点合并风险比:ICD风暴为0.61(95%CI 0.36~1.03),ICD电击次数为0.37(95%CI 0.22~0.63),ICD事件为0.39(95%CI 0.25~0.61)以及死亡为0.80(95%CI 0.45~1.44)。各研究合并的室性心律失常复发率为34%(95%CI 0.26~0.41),合并的每月ICD治疗次数为0.05(95%CI-0.03~0.13)。结论:与单纯植入ICD相比,ICD植入联合射频消融可成为室性心律失常且(或)合并有结构性心脏病患者的更好治疗选择,体现在可明显减少ICD事件以及ICD电击次数,但并不能减少ICD风暴和死亡的风险。

Objective:A systematic review and meta analysis was conducted to evaluate the efficacy of treated with implantable cardioverter-defibrillators(ICDs)and catheter ablation in patients with ventricular arrhythmia.Method:Relevant studies were identified by searches of MEDLINE and EMBASE databases until December 21,2018 and by reviewing the reference lists from retrieved articles.Randomized controlled trials and cohort studies reporting ICD storms,ICD shocks,ICD events,ventricular arrhythmia recurrences,and ICD therapies per month were included.Summary estimates of association were obtained by using a random-effects model.Result:Twelve studies were included in the meta analysis.The outcomes in ICD implantation plus catheter ablation group were better than those in ICD implantation only group.The pooled hazard ratios(HRs)were 0.61(95%confidence interval[CI]:0.36-1.03)for ICD storms,0.37(95%CI:0.22-0.63)for ICD shocks,0.39(95%CI:0.25-0.61)for ICD events,and 0.80(95%CI:0.45-1.44)for cardiac death,respectively.The pooled weighted ventricular arrhythmia recurrence proportion was 34%(95%CI:0.26-0.41),and ICD therapies per month was 0.05(95%CI:-0.03-0.13).Conclusion:Compared with ICD implantation only,ICD implantation plus catheter ablation may be a choice for patients with VTs and or a history of structural heart diseases,which can reduce the ICD events and ICD therapies,but has no effect on either the ICD storms or death.