环肺静脉联合额外部位消融降低心房颤动射频消融术后复发有效性的meta分析

The efficacy of circumferential pulmonary vein combined with additional ablation in reducing recurrence of atrial fibrillation after radiofrequency ablation:a meta-analysis

目的:探究相比于单纯环肺静脉消融(CPVI),CPVI联合额外部位消融(包括二尖瓣环峡部、三尖瓣环峡部、上腔静脉、左心房顶部、左心房后壁、Marshall静脉、复杂碎裂电位、神经节)是否降低消融术后房颤(AF)的复发率。方法:计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Cochrane Library等数据库,筛选出近10年符合标准的随机对照研究,应用Stata软件进行meta分析,比较单纯CPVI与CPVI联合额外部位消融策略在消融后AF复发中的差异。结果:共纳入21篇文献。meta分析结果表明,与单纯CPVI相比,CPVI联合额外部位消融未降低AF复发率。根据额外消融部位、AF类型、左心房内径、AF持续时间进行亚组分析,发现只在较小的左心房内径亚组中,CPVI联合额外部位消融进一步降低AF的复发率(OR=0.68,95%CI:0.47~0.98,P=0.040),在其他亚组中未发现上述现象。结论:相比于单纯CPVI,CPVI联合额外部位的消融策略未降低消融后AF的复发率。

Objective To investigate whether circumferential pulmonary vein isolation(CPVI) combined with additional ablation(mitral isthmus, tricuspid isthmus, superior vena cava, left atrial roof, left atrial posterior wall, the vein of marshall, complex fractionated atrial electrograms, ganglionated plexi) reduces the recurrence rate of atrial fibrillation(AF) compared with CPVI alone.Methods A literature search was conducted using the databases CNKI, WanFang, VIP, CBM, PubMed, Embase, Cochrane Library. Randomized controlled studies that met the standards in the past ten years were screened out, and the relevant literature contents were meta-analyzed by Stata software. The content about comparing CPVI alone with CPVI combined with the additional ablation strategies in the recurrence of AF was summarized.Results A total of 21 papers were included. Meta-analysis showed that no significant difference between CPVI alone and CPVI combined ablation strategies in reducing AF recurrence. Subgroup analysis based on additional ablation site, AF type, left atrial diameter, AF diagnosis time, and outcome indicators showed that only in the small left atrial diameter subgroup, CPVI combined with additional ablation further reduced the recurrence rate of AF(OR=0.68, 95%CI: 0.47-0.98, P=0.040), which was not found in other subgroups.Conclusion The ablation strategy of CPVI combined with additional sites does not reduce the recurrence rate of AF compared with CPVI alone.