持久性心房动患者的辅助后壁隔离:系统性审查和元分析
André Rivera1, Antônio S Menezes2, Douglas Mesadri Gewehr3,4
1Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil.
Heart rhythm O2
|April 9, 2025
概括
将后壁隔离 (PWI) 添加到肺静脉隔离 (PVI) 中,可显著降低持续性心房动 (PeAF) 患者心房动脉节拍复发的发生率. 这种综合方法是安全的,对长期的PeAF特别有益.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 干预心脏病学 干预心脏病学
背景情况:
- 肺静脉隔离 (PVI) 是对心房动 (AF) 的主要治疗方法.
- 对于持续性心房动 (PeAF) 的PVI的疗效有限.
- 在PeAF中辅助后壁切除的作用尚不清楚.
研究的目的:
- 在PeAF患者中,系统地审查和元分析带有或没有后壁隔离 (PWI) 的PVI的有效性.
- 评估辅助PWI对心房动脉节律失常 (ATA) 复发和安全结果的影响.
主要方法:
- 在PubMed,Embase,Cochrane和ClinicalTrials.gov系统搜索随机对照试验 (RCT).
- 使用随机效应模型进行元分析.
- 包括8个RCT,包括1104名患者 (546名PVI,558名PVI+PWI).
主要成果:
- 与单独的PVI相比,辅助PWI显著增加了对ATA复发的自由度 (RR 1.13,P=.036).
- 一项亚分析显示,长期患有PeAF的患者的效果更大 (RR 1.76,P=.04).
- 直接后壁切除有利于辅助PWI (RR1.39,P<.01),在不良事件中没有显著差异.
结论:
- 附加PWI与PVI在减少PeAF患者的ATA复发方面是有效的,而不会影响安全性.
- 长期患有PeAF的患者可能会从PWI的添加中获得更大的益处.
- 这些发现支持PVI加PWI作为管理PeAF的有效策略.
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