Radiofrequency ablation in treating pre-excited atrial fibrillation recurrence: A meta analysis

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

Abstract

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

CLC Number:

R541.7

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.10.003

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

Figures/Tables 6

References 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)