Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation A Meta-Analysis
Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation A Meta-Analysis
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DOI：
10.1536/ihj.16-460
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发表时间：
2017-07-01
影响因子：
1.5
通讯作者：
He, Yan
中科院分区：
文献类型：
--
作者：
Li, Jin-yi;Jiang, Jing-bo;He, Yan
目前，射频消融(RFCA)治疗房颤的基础是肺静脉隔离(PVI)。为了提高成功率和降低复发率，一些研究探讨了经验性SVC隔离(SVCI)在传统PVI基础上的疗效。然而，这些研究的结果提供了相互矛盾的数据。我们进行了一项荟萃分析，以评估经验性SVCI与传统SVCI相比在阵发性心房颤动(PAF)消融中的有效性和安全性。我们检索了MEDLINE、EMBASE、Web of Science和Cochrane数据库，从1986年1月到2016年8月期间，确定了合格的研究。主要临床结果是房性快速性心律失常的复发率，次要临床结果是手术时间、透视时间和并发症。我们确定了3项随机对照试验(RCT)和1项非随机观察性研究(NRO)，涉及245例经验性SVCI患者和269例常规SVCI患者。经验性室性心动过速复发率(16.7%)明显低于常规室性心律失常复发率(29.4%，OR：0.48，95%CI：0.31~0.74，P=0.0009)。两组在透视时间(P=0.22)、手术时间(P=0.32)、临床并发症(P=0.33)等方面差异无统计学意义，但在相同的透视时间、手术时间和临床并发症的情况下，经验式SVCI较传统SVCI在单次PVI术后的远期疗效更好。
Radiofrequency catheter ablation (RFCA) in the treatment of AF is currently based on pulmonary vein isolation (PVI). Some studies have investigated the efficacy of empiric SVC isolation (SVCI) in addition to conventional PVI in order to improve success rates and reduce recurrence rates. However, the results of the studies have given conflicting data.We performed a meta-analysis to evaluate the efficacy and safety of the empiric SVCI compared with conventional SVCI for paroxysmal atrial fibrillation (PAF) ablation.We searched MEDLINE, EMBASE, the Web of Science, and the Cochrane Database from the period January 1986 to August 2016 and identified qualified studies. The primary clinical outcome was the recurrence rate of atrial tachyarrhythmias, and the secondary clinical outcomes were procedure time, fluoroscopy time, and complications.We identified 3 randomized controlled trials (RCTs) and one nonrandomized, observational study (nROS) involving 245 patients with empiric SVCI and 269 patients with conventional SVCI. The empiric SVCI group had a lower recurrence rate of atrial tachyarrhythmia after a single procedure compared with the conventional SVCI group (16.7% versus 29.4%, OR: 0.48, 95%CI: 0.31 to 0.74, P = 0.0009). There was no significant difference in fluoroscopic time (P = 0.22), procedure time (P = 0.32), or clinical complications (P = 0.33) between the two groups.Empiric SVCI is more effective than conventional SVCI in terms of the long-term outcomes of PAF patients after a single PVI procedure, with the same fluoroscopic time, procedure time, and clinical complications.