摘要
目的系统评价消融指数指导心房颤动射频消融的有效性和安全性。方法计算机检索PubMed、Embase、The Cochrane Library、中国期刊全文数据库、万方数据库及维普数据库。搜集有关消融指数指导下行射频消融(试验组)与组织接触压力指导下行射频消融(对照组)的有效性及安全性比较的研究。提取相关数据并按照纽卡斯尔-渥太华量表完成文献质量评价,采用RevMan 5.4和Stata 14.0统计软件进行荟萃分析。结果共纳入12项研究,共计2 370例受试者。荟萃分析结果显示,试验组的手术时间(MD=-12.44,95%CI-21.57~-3.30,P=0.008)、透视时间(MD=-3.70,95%CI-4.73~-2.66,P<0.001)和消融时间(MD=-3.40,95%CI-4.93~-1.88,P<0.001)相较于对照组均显著减少。试验组的单圈隔离率相较于对照组显著增加(OR=0.41,95%CI 0.32~0.52,P<0.001)。试验组的急性肺静脉电传导恢复风险(OR=0.34,95%CI 0.19~0.60,P<0.001)和术后心房颤动复发风险(OR=0.48,95%CI 0.40~0.59,P<0.001)相较于对照组显著减少。而在手术并发症风险方面,两组比较差异无统计学意义(OR=0.52,95%CI 0.25~1.09,P=0.08)。结论消融指数指导心房颤动射频消融能够显著地减少手术时间、透视时间和消融时间,在提高单圈隔离率的同时,降低了急性肺静脉电传导恢复的风险和术后心房颤动复发风险,并且不会增加手术并发症的发生。
Objective To systematically evaluate the efficacy and safety of ablation index in guiding radiofrequency ablation of atrial fibrillation.Methods Computer searches of PubMed, Embase, the Cochrane Library, the Chinese journal full text database, Wanfang database, and VIP database were performed.Collection of studies about the efficacy and safety comparison between radiofrequency ablation guided by ablation index(trial group) and radiofrequency ablation guided by contact force(control group).Relevant data were extracted and the literature quality evaluation was completed according to the Newcastle-Ottawa Scale.RevMan 5.4 and Stata 14.0 statistical software were adopted for the meta-analysis.Results 12 studies with 2 370 subjects were included.The results of the meta-analysis showed that the procedure time(MD=-12.44,95%CI-21.57~-3.30,P=0.008),fluoroscopy time(MD=-3.70,95%CI-4.73~-2.66,P<0.001),and ablation time(MD=-3.40,95%CI-4.93~-1.88,P<0.001) in the trial group were significantly reduced compared with the control group.The rate of isolation after single encirclement in the trial group was significantly increased compared with the control group(OR=0.41,95%CI 0.32~0.52,P<0.001).The risk of recovery of acute pulmonary venous electrical conduction(OR=0.34,95%CI 0.19~0.60,P<0.001) and the risk of postoperative atrial fibrillation recurrence(OR=0.48,95%CI 0.40~0.59,P<0.001) were significantly reduced in the trial group compared with the control group.However, for the risk of procedural complications, there was no significant difference between the two groups(OR=0.52,95%CI 0.25~1.09,P=0.08).Conclusion Radiofrequency ablation guided by ablation index can significantly reduce procedure time, fluoroscopy time, and ablation time while increasing the rate of isolation after single encirclement, reducing the risk of recovery of acute pulmonary venous electrical conduction and postoperative atrial fibrillation recurrence without additional procedural complications.
作者
李宸
章海燕
徐少华
许海南
张祖宏
龙明智
LI Chen;ZHANG Haiyan;XU Shaohua;XU Hainan;ZHANG Zuhong;LONG Mingzhi(Nanjing Medical University Graduate School,Nanjing 211166,Jiangsu,China;Department of Cardiology,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,Jiangsu,China)
出处
《心血管病学进展》
CAS
2022年第2期171-177,共7页
Advances in Cardiovascular Diseases
基金
南京市医学重点科技发展项目(ZKX18051)。
关键词
消融指数
心房颤动
射频消融
荟萃分析
Ablation index
Atrial fibrillation
Radiofrequency ablation
Meta-analysis
