期刊论文详细信息
INTERNATIONAL JOURNAL OF CARDIOLOGY 卷:266
Association of catheter ablation for atrial fibrillation with mortality and stroke: A systematic review and meta-analysis
Review
Barra, Sergio1  Baran, Jakub1,2  Narayanan, Kumar3,4  Boveda, Serge5  Fynn, Simon1  Heck, Patrick1  Grace, Andrew1  Agarwal, Sharad1  Primo, Joao6  Marijon, Eloi3,7,8  Providencia, Rui9 
[1] Papworth Hosp NHS Fdn Trust, Cardiol Dept, Cambridge, England
[2] Grochowski Hosp, Postgrad Med Sch, Dept Cardiol, Div Clin Electrophysiol, Cambridge, England
[3] Paris Cardiovasc Res Ctr, Paris, France
[4] MaxCure Hosp, Cardiol Dept, Hyderabad, India
[5] Clin Pasteur, Cardiol Dept, Toulouse, France
[6] VN Gaia Hosp Ctr, Cardiol Dept, Vn Gaia, Portugal
[7] Hop Europeen Georges Pompidou, Cardiol Dept, Paris, France
[8] Paris Descartes Univ, Paris, France
[9] Barts Hlth NHS Trust, Barts Heart Ctr, London, England
关键词: Ablation;    Atrial fibrillation;    Mortality;    Stroke;    Meta-analysis;   
DOI  :  10.1016/j.ijcard.2018.03.068
来源: Elsevier
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【 摘 要 】

Background: Maintenance of sinus rhythm has been associated with lower mortality, but whether atrial fibrillation (AF) ablation per se benefits hard outcomes such as mortality and stroke is still debated. Objective: To determine whether AF ablation is associated with a reduction in all-cause mortality and stroke compared with medical therapy alone. Methods: Literature search looking for both randomized and observational studies comparing AF catheter ablation vs. medical management. Data pooled using random-effects. Risk ratios (RR) with 95% confidence intervals (CI) used as a measure of treatment effect. The primary and secondary outcomes were all-cause mortality and occurrence of cerebrovascular events during follow-up, respectively. Results: Thirty studies were eligible for inclusion, comprising 78,966 patients (25,129 receiving AF ablation and 53,837 on medical treatment) and 233,990 patient-years of follow-up. The pooled data of studies revealed that ablation was associated with lower risk of all-cause mortality: 5.7% vs. 17.9%; RR = 0.44, 95% CI 0.32-0.62, p < 0.001. In a sensitivity analysis by study design, a survival benefit of AF ablation was seen in randomized studies, with no heterogeneity (mortality risk 4.2% vs. 8.9%; RR=0.55, 95% CI 0.39-0.79, p=0.001, I-2=0%), and also in observational studies, but with marked heterogeneity (6.1% vs. 18.3%; RR= 0.39, 95% CI 0.26-0.59, p < 0.001, I-2 = 95%). The mortality benefit in randomized studies was mainly driven by trials performed in patients with left ventricular (LV) dysfunction and heart failure. The pooled risk of a cerebrovascular event was lower in patients receiving AF ablation (2.3% vs. 5.5%; RR= 0.57, 95% CI 0.46-0.70, p < 0.001, I-2= 62%), but no differencewas seen in randomized trials (2.2% vs. 2.1%; RR= 0.94, 95% CI 0.46-1.94, p = 0.87, I-2 = 0%). Conclusions: Ablation of atrial fibrillation associates with a survival benefit compared with medical treatment alone, although evidence is restricted to the setting of heart failure and LV systolic dysfunction. (C) 2018 Elsevier B.V. All rights reserved.

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