节奏与节奏控制策略对心房动:对随机对照试验的元分析
Stefanos Zafeiropoulos1, Ioannis Doundoulakis2, Alexandra Bekiaridou3
1Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA; Department of Cardiology, University Hospital Zurich, Zürich, Switzerland.
JACC. Clinical electrophysiology
|May 10, 2024
概括
与节律控制相比,对心房动 (AF) 的节律控制策略显著减少了心血管死亡,中风和心力衰竭住院治疗. 当代的方法,特别是导管切除,推动了AF管理中的这些改善结果.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 临床试验 临床试验
背景情况:
- 前庭动 (AF) 的管理依赖于节律或节率控制策略.
- 节律控制在改善临床结果方面优于节律控制的优势仍然存在争议,尽管它的使用越来越多.
研究的目的:
- 系统地评估和比较节律控制与节律控制策略在心房的管理中的有效性.
- 评估这些治疗方法的总和时间变化的证据.
主要方法:
- 从主要数据库 (MEDLINE,CENTRAL,Web of Science) 来进行随机对照试验 (RCT) 的系统审查和元分析,截至2023年11月.
- 包括的研究比较了非膜性AF中节律控制 (抗失节药物,导管切除,心脏转变) 与节律控制 (β阻塞剂,数字化药物,抗剂) 的研究.
- 主要结局:心血管死亡. 二次结果:全因死亡,中风,心力衰竭住院治疗,鼻节律和不良事件. 进行了累积和元回归分析.
主要成果:
- 分析了18个涉及17536名患者的RCT.
- 与节律控制相比,节律控制显著减少了心血管死亡 (HR 0.78),中风 (HR 0.801) 和心力衰竭住院治疗 (HR 0.80).
- 主要在当代研究中观察到好处,随着导管切除的使用增加,与更好的结果相关,不包括中风.
结论:
- 当代节律控制策略在治疗心房动方面优于节律控制.
- 节律控制可以降低心血管死亡率,心力衰竭事件和AF患者中风.
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