射频消融在心房颤动伴射血分数降低心力衰竭患者中的治疗价值的荟萃分析

Therapeutic value of radiofrequency ablation in patients with atrial fibrillation and heart failure with reduced ejection fraction:a systematic review and meta-analysis

目的评估导管射频消融对心房颤动合并射血分数降低心力衰竭(HFrEF)患者的心功能改善方面是否优于药物治疗。方法系统检索了PubMed、Embase、Cochrane图书馆中对比导管射频消融和药物治疗心房颤动合并HFrEF患者的随机对照试验,并比较两者对心功能的改善作用。结果纳入8项随机对照试验的1166例患者。相比于药物治疗,射频消融提高了患者的窦性心律维持率(68.1%比18.2%,OR=17.48,95%CI:6.79~45.02,P=0.000)、射血分数(MD=6.59%,95%CI:2.49%~10.69%,P=0.002)、6 min步行试验距离(MD=24.18 m,95%CI:5.67~42.69 m,P=0.001)、生活质量(MD=-8.03,95%CI:-14.33~-1.72,P=0.01)和氧消耗量(MD=3.17 ml·kg^(-1)·min^(-1),95%CI:1.05~5.28 ml·kg^(-1)·min^(-1),P=0.003),有更低的全因死亡率(8.7%比17.5%,OR=0.45,95%CI:0.30~0.67,P=0.000)和更低的心力衰竭再入院率(20.8%比35.8%,OR=0.44,95%CI:0.30~0.63,P=0.000)。在不良事件的发生率方面,两者无统计学差异(43.3%比39.5%,OR=1.29,95%CI:0.76~2.19,P=0.34)。结论对于心房颤动合并HFrEF的患者,导管射频消融治疗在心功能改善方面优于药物治疗。

Objective To evaluate whether catheter radiofrequency ablation for patients with atrial fibrillation and heart failure with reduced ejection fraction(HFrEF)has a more significant effect than drug therapy in improving cardiac function.Methods A systematic search of randomized controlled trials(RCTs)in PubMed,Embase,and Cochrane libraries for comparing catheter radiofrequency ablation with drug therapy for patients with atrial fibrillation and HFrEF and the two groups’effects on improving heart function were compared.Results A total of 8 RCTs were included in this meta-analysis,involving 1166 patients.Compared with drug therapy,radiofrequency ablation was associated with increased rate of sinus rhythm maintenance(68.1%vs.18.2%,OR=17.48,95%CI:6.79-45.02,P=0.000),level of ejection fraction(MD=6.59%,95%CI:2.49%-10.69%,P=0.002),6-minute walk test distance(MD=24.18 m,95%CI:5.67-42.69 m,P=0.001),quality of life(MD=-8.03,95%CI:-14.33 to-1.72,P=0.01),VO2(MD=3.17 ml·kg^(-1)·min^(-1),95%CI:1.05-5.28 ml·kg^(-1)·min^(-1),P=0.003),lower all-cause mortality rate(8.7%vs.17.5%,OR=0.45,95%CI:0.30-0.67,P=0.000)and rehospitalization rate for heart failure(20.8%vs.35.8%,OR=0.44,95%CI:0.30-0.63,P=0.000).There was no significant difference in the incidence of adverse events(43.3%vs.39.5%,OR=1.29,95%CI:0.76-2.19,P=0.34).Conclusions For patients with atrial fibrillation and HFrEF,catheter radiofrequency ablation is superior to drug therapy in improving cardiac function.