Association between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation: a systematic review and meta-analysis of observational studies
Association between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation: a systematic review and meta-analysis of observational studies
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单周肺静脉隔离后左心房大小与心房颤动复发之间的关联：观察性研究的系统回顾和荟萃分析
DOI：
10.1093/europace/eur364
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发表时间：
2012-05-01
期刊：
影响因子：
6.1
通讯作者：
Xu, Yawei
中科院分区：
文献类型：
--
作者：
Zhuang, Jianhui;Wang, Yi;Xu, Yawei
左房(LA)扩大与房颤(AF)相关。然而，心房扩张是否能预测消融后房颤的复发仍存在争议。我们进行了系统的综述和荟萃分析，以分析单个环状肺静脉隔离术(CPVI)后左房直径与房颤复发之间的关系，并探索其可能的机制。所有纳入的研究均可获得左房前后径，并在收缩末期用M型经胸超声心动图测量。根据随访时间进行亚组分析。根据统计异质性，采用随机效应模型或固定效应模型计算加权平均差(WMD)和95可信区间(CI)。共有22项研究，总计3750名个体符合纳入标准。复发与未复发患者左房直径的总和为1.87 mm(95可信区间1.262.48，P<0.001)。22项研究的Meta回归分析表明，研究设计、随访时间和无症状复发的测量是异质性的重要来源。敏感性分析表明，无论随访多长时间，有无复发的患者之间的左房直径差异持续存在。扩张的左房显著增加单一CPVI后房颤复发的风险。这尤其适用于长期随访的患者。
Left atrial (LA) enlargement is associated with atrial fibrillation (AF). However, it is controversial whether dilated atrium can predict post-ablation AF recurrence. We undertook a systematic review and meta-analysis to analyse the association between LA diameter and AF recurrence after single circumferential pulmonary vein isolation (CPVI) and explore the potential mechanism.Electronic databases and bibliographies of retrieved studies were searched. The anteroposterior diameters of LA were available in all included studies, which were measured at end-systole by M-mode transthoracic echocardiography. Subgroup analysis was conducted based on the duration of follow-up. Weighted mean difference (WMD) and 95 confidence interval (CI) were calculated using random-effect or fixed-effect model, depending on statistical heterogeneity. Twenty-two studies with a total of 3750 individuals met the inclusion criteria. The summary WMD of LA diameter between patients with and without recurrence was 1.87 mm (95 CI 1.262.48, P 0.001). Meta-regression analysis of the 22 studies indicated that study design, duration of follow-up, and measurement of asymptomatic recurrences were significant sources of heterogeneity. Sensitivity analysis suggested that the difference in LA diameter between patients with and without recurrences persisted regardless of the duration of follow-up.Dilated LA significantly increases the risk of AF recurrence after single CPVI. This is especially applicable to the patients with long-term follow-up.