预激综合征伴心房颤动射频消融术后心房颤动复发率的meta分析

doi:10.3969/j.issn.1004-583X.2022.10.003

摘要/Abstract

摘要：

目的探讨预激综合征伴心房颤动射频消融术后心房颤动的复发率,为临床预防和干预提供理论依据。方法计算机检索 PubMed、Web of Science、The Cochrane Library、Embase、CNKI、WanFang Data、CBM及VIP数据库,搜索建库至2022年3月26日与预激综合征伴心房颤动患者行射频消融术治疗后心房颤动复发率相关的研究。由2名研究员独立筛选文献、提取资料并文献质量评价,采用R 4.1.0软件进行meta分析。结果纳入14篇研究,共计851例患者,meta分析结果显示预激综合征伴心房颤动射频消融术后心房颤动的总复发率为0.13(95%CI:0.08~0.19,P<0.01)。其中,亚组分析显示:单纯房室旁道消融术和房室旁道消融联合肺静脉隔离术复发率分别为:0.15(95%CI:0.09~0.21,P<0.01)和0.07(95%CI:0.01~0.15,P<0.01);单旁道和多旁道复发率分别为0.19(95%CI:0.12~0.28,P=0.01)和0.05(95%CI:0.00~0.20,P=0.10);左侧和右侧旁道复发率分别为0.14(95%CI:0.07~0.21,P<0.01)和0.10(95%CI:0.06~0.16,P=0.07);年龄≤40岁和>40岁复发率分别为0.10(95%CI:0.01~0.23,P<0.01)和0.15(95%CI:0.09~0.21,P<0.01);随访时间≤1年和>1年复发率分别为0.08(95%CI:0.02~0.17,P=0.09)和0.17(95%CI:0.14~0.21,P=0.17);样本量≤50例和>50例复发率分别为0.18(95%CI:0.09~0.29,P<0.01)和0.11(95%CI:0.06~0.17,P<0.01);男性和女性复发率分别为0.10(95%CI:0.04~0.19,P<0.01)和0.19(95%CI:0.12~0.28,P=0.26);合并器质性心脏病和不合并复发率分别为0.34(95%CI:0.15~0.57,P<0.01)和0.04(95%CI:0.00~0.10,P<0.01)。结论当前证据表明,预激综合征伴心房颤动射频消融术后心房颤动的复发率较高,相对于单纯房室旁道消融,旁道消融联合肺静脉隔离降低复发率效果更优,年龄及随访时间与复发率呈正相关。

关键词: 预激综合征, 心房颤动, 射频消融, 复发率, meta分析

Abstract:

Objective To explore the effectiveness of radiofrequency ablation (RFA) in treating pre-excited atrial fibrillation(AF) recurrence, aiming to provide theoretical basis for clinical practice. Methods Related studies regarding the treatment of RFA in pre-excited AF recurrence were searched in PubMed, Embase, CNKI, and Wanfang using a computer. Data collection for this study took place from the establishment to March 26, 2022. Two researchers independently screened the literature and extracted information and evaluated the quality of the literature, and R4.1.0 software was applied for Meta-analysis. Results Fourteen studies representing 851 patients were included. After RFA intervention, the overall AF recurrence rate was 0.13(95%CI: 0.08-0.19, P<0.01) in Meta-analysis result. Wherein, the subgroup analysis showed that the AF recurrence rate of accessory pathway (AP) ablation alone and AP+ pulmonary vein isolation (PVI) was 0.15(95%CI: 0.09-0.21, P<0.01) and 0.07 (95%CI: 0.01-0.15, P<0.01), respectively. The AF recurrence rates of unilateral bypass and multiple bypass were 0.19(95%CI: 0.12-0.28, P=0.01) and 0.05(95%CI: 0.00-0.20, P=0.10), respectively; the AF recurrence rates of left side tract and right side tract were 0.14(95%CI: 0.07-0.21, P<0.01) and 0.10(95%CI: 0.06-0.16, P=0.07), respectively; the AF recurrence rates of patients aged ≤40 years old and >40 years old were 0.10(95%CI: 0.01-0.23, P<0.01) and 0.15(95%CI: 0.09-0.21, P<0.01) respectively; the AF recurrence rates of patients with follow-up ≤1 year and >1 year was 0.08(95%CI: 0.02-0.17, P=0.09) and 0.17(95%CI: 0.14-0.21, P=0.17), respectively; the AF recurrence rates of sample size ≤50 cases and >50 cases were 0.18(95%CI: 0.09-0.29, P<0.01) and 0.11(95%CI: 0.06-0.17, P<0.01), respectively; the AF recurrence rates of men and women were 0.10(95%CI: 0.04-0.19, P<0.01) and 0.19(95%CI: 0.12-0.28, P=0.26), respectively; the AF recurrence rates of patients with and without organic heart disease were 0.34(95%CI: 0.15-0.57, P<0.01) and 0.04(95%CI: 0.00-0.10, P<0.01), respectively. Conclusion After RFA, current evidences suggest a higher AF recurrence rate, AP + PVI is superior to AP alone for reducing the recurrence rate, and the age and follow-up time are positively associated with the AF recurrence rate.

Key words: pre-excitation syndromes, atrial fibrillation, radiofrequency ablation, recurrence rate, Meta-analysis

中图分类号:

R541.7

安景景, 王小娟, 邓爱云. 预激综合征伴心房颤动射频消融术后心房颤动复发率的meta分析[J]. 临床荟萃, 2022, 37(10): 899-904.

An Jingjing, Wang Xiaojuan, Deng Aiyun. Radiofrequency ablation in treating pre-excited atrial fibrillation recurrence: A meta analysis[J]. Clinical Focus, 2022, 37(10): 899-904.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.10.003

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I10/899

图/表 6

参考文献 23

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纳入研究	国家	研究类型	消融方式	样本量(例)	复发例数(例)	随访时间(月)	NOS评分
Chen^[3] 2020	中国	队列	①	23	10	22.6±11.1	7
Kawabata^[4] 2016	日本	队列	①②	96	22	23.63	8
Mujović^[5] 2010	塞尔维亚	队列	①	52	9	62.4	7
Wu^[6] 2020	中国	队列	①②	160	22	30.9±9.2	8
包萍^[7] 2011	中国	队列	①	57	6	41.5±26.4	7
范西真^[8] 2012	中国	队列	①②	58	0	3~42	6
韩秀清^[9] 2019	中国	队列	①②	89	5	6	7
莫静兰^[10] 2017	中国	队列	①	34	1	3	6
覃凯^[11] 2020	中国	队列	①	13	2	6	6
王君涛^[12] 2014	中国	队列	①②	39	7	3~24	7
温旭涛^[13] 2013	中国	队列	①	45	9	24	7
吴金涛^[14] 2021	中国	队列	①	67	11	31.6±10.0	8
张海涛^[15] 2017	中国	队列	①②	73	7	/	7
周玮^[16] 2018	中国	队列	①	45	8	24	6

纳入研究	国家	研究类型	消融方式	样本量(例)	复发例数(例)	随访时间(月)	NOS评分
Chen^[3] 2020	中国	队列	①	23	10	22.6±11.1	7
Kawabata^[4] 2016	日本	队列	①②	96	22	23.63	8
Mujović^[5] 2010	塞尔维亚	队列	①	52	9	62.4	7
Wu^[6] 2020	中国	队列	①②	160	22	30.9±9.2	8
包萍^[7] 2011	中国	队列	①	57	6	41.5±26.4	7
范西真^[8] 2012	中国	队列	①②	58	0	3~42	6
韩秀清^[9] 2019	中国	队列	①②	89	5	6	7
莫静兰^[10] 2017	中国	队列	①	34	1	3	6
覃凯^[11] 2020	中国	队列	①	13	2	6	6
王君涛^[12] 2014	中国	队列	①②	39	7	3~24	7
温旭涛^[13] 2013	中国	队列	①	45	9	24	7
吴金涛^[14] 2021	中国	队列	①	67	11	31.6±10.0	8
张海涛^[15] 2017	中国	队列	①②	73	7	/	7
周玮^[16] 2018	中国	队列	①	45	8	24	6

亚组	纳入研究数量	异质性检验结果		Meta分析结果合并率(95%CI)
亚组	纳入研究数量	I²值(%)	P值	Meta分析结果合并率(95%CI)
消融方式
AP消融	13^{[3⇓⇓⇓⇓⇓⇓-10,12⇓⇓⇓ -16]}	73	<0.01	0.15(0.09~0.21)
AP消融联合PVI	7^{[4,6,8 -9,11 -12,15]}	70	<0.01	0.07(0.01~0.15)
AP数量
单旁道	6^{[3-4,7,13 -14,16]}	65	0.01	0.19(0.12~0.28)
多旁道	5^{[4,7,13 -14,16]}	49	0.10	0.05(0.00~0.20)
AP位置
左侧	8^{[4-5,7 -8,13⇓⇓ -16]}	64	<0.01	0.14(0.07~0.21)
右侧	8^{[4-5,7 -8,13⇓⇓ -16]}	47	0.07	0.10(0.06~0.16)
平均年龄(岁)
≤40	4^[7-8,13,16]	87	<0.01	0.10(0.01~0.23)
>40	10^{[3⇓⇓-6,9⇓⇓ -12,14 -15]}	70	<0.01	0.15(0.09~0.21)
随访时间(年)
≤1	4^[9⇓⇓-12]	54	0.09	0.08(0.02~0.17)
>1	8^{[3⇓⇓⇓-7,13 -14,16]}	48	0.17	0.17(0.14~0.21)
样本量(例)
≤50	6^{[3,10⇓⇓ -13,16]}	67	<0.01	0.18(0.09~0.29)
>50	8^{[4⇓⇓⇓⇓-9,14 -15]}	80	<0.01	0.11(0.06~0.17)
性别
男性	7^{[4-5,7 -8,13⇓ -15]}	77	<0.01	0.10(0.04~0.19)
女性	7^{[4-5,7 -8,13⇓ -15]}	22	0.26	0.19(0.12~0.28)
器质性心脏病
合并	6^{[4-5,7 -8,13 -14]}	77	<0.01	0.34(0.15~0.57)
不合并	6^{[4-5,7 -8,13 -14]}	68	<0.01	0.04(0.00~0.10)

亚组	纳入研究数量	异质性检验结果		Meta分析结果合并率(95%CI)
亚组	纳入研究数量	I²值(%)	P值	Meta分析结果合并率(95%CI)
消融方式
AP消融	13^{[3⇓⇓⇓⇓⇓⇓-10,12⇓⇓⇓ -16]}	73	<0.01	0.15(0.09~0.21)
AP消融联合PVI	7^{[4,6,8 -9,11 -12,15]}	70	<0.01	0.07(0.01~0.15)
AP数量
单旁道	6^{[3-4,7,13 -14,16]}	65	0.01	0.19(0.12~0.28)
多旁道	5^{[4,7,13 -14,16]}	49	0.10	0.05(0.00~0.20)
AP位置
左侧	8^{[4-5,7 -8,13⇓⇓ -16]}	64	<0.01	0.14(0.07~0.21)
右侧	8^{[4-5,7 -8,13⇓⇓ -16]}	47	0.07	0.10(0.06~0.16)
平均年龄(岁)
≤40	4^[7-8,13,16]	87	<0.01	0.10(0.01~0.23)
>40	10^{[3⇓⇓-6,9⇓⇓ -12,14 -15]}	70	<0.01	0.15(0.09~0.21)
随访时间(年)
≤1	4^[9⇓⇓-12]	54	0.09	0.08(0.02~0.17)
>1	8^{[3⇓⇓⇓-7,13 -14,16]}	48	0.17	0.17(0.14~0.21)
样本量(例)
≤50	6^{[3,10⇓⇓ -13,16]}	67	<0.01	0.18(0.09~0.29)
>50	8^{[4⇓⇓⇓⇓-9,14 -15]}	80	<0.01	0.11(0.06~0.17)
性别
男性	7^{[4-5,7 -8,13⇓ -15]}	77	<0.01	0.10(0.04~0.19)
女性	7^{[4-5,7 -8,13⇓ -15]}	22	0.26	0.19(0.12~0.28)
器质性心脏病
合并	6^{[4-5,7 -8,13 -14]}	77	<0.01	0.34(0.15~0.57)
不合并	6^{[4-5,7 -8,13 -14]}	68	<0.01	0.04(0.00~0.10)