症状のない前興奮の患者で心律不全と突然死のリスク:メタ解析
Manoj N Obeyesekere1, Peter Leong-Sit, David Massel
1Division of Cardiology, University of Western Ontario, London, Ontario, Canada. manojobey@yahoo.com
Circulation
|April 26, 2012
まとめ
このメタアナリシスでは,症状のないウルフ・パーキンソン・ホワイト心電図パターンの急性心臓死 (SCD) と上心室性短心症の発生率が低いことが示されました. これらの発見は,ほとんどの患者にとって,通常の侵襲的な管理が不要であることを示唆しています.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- 予防医学は,予防的な医療です.
背景:
- Wolff-Parkinson-White (WPW) ECGパターンの無症状患者における突然心死 (SCD) と上心室性短心 (SVT) のリスクはよく定義されていません.
- これらの患者に対する現在の管理戦略は依然として議論の余地があります.
研究 の 目的:
- 症状のないWPW ECGパターンの患者におけるSCDとSVTの発生率を決定する.
- 臨床管理の決定を根拠に証拠を提供すること.
主な方法:
- 英語研究のためのEMBASEとMedlineのデータベースを体系的に検索する.
- 切除手術を受けていない無症状前刺激患者の前向き,後向き,ランダム化,またはコホート研究を含む.
- 1869人の患者を対象とした20件の研究から得られたデータのメタ分析.
主要な成果:
- 11,722人/年に合計10件のSCDが報告され,推定リスクは1000人/年に1.25であった.
- 9884人年において156件のSVTが報告され,1000人年あたり16件のイベントのリスクがありました.
- 子どもは,成人と比較して,SCDとSVTの両方のイベント率が数値的に高いことを示しました.
結論:
- 症状のないWPW患者におけるSCDとSVTの低発生率は,通常の侵襲的管理をサポートしていません.
- 臨床的決定は,リスクの階層化に基づいて個別化されるべきである.
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