Early rhythm control compared to rate control in atrial fibrillation – A systematic review, meta-analysis, and meta-regression

Q3 Medicine

Indian Pacing and Electrophysiology Journal Pub Date : 2025-03-01 DOI:10.1016/j.ipej.2025.02.003

Katherine Hermanto, Raymond Pranata, Hawani Sasmaya Prameswari, Giky Karwiky, Chaerul Achmad, Mohammad Iqbal

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引用次数: 0

Abstract

Background

This meta-analysis aimed to compare the effectiveness of early rhythm control to rate control, and whether catheter ablation derived more benefit compared to other methods of rhythm control.

Methods

A comprehensive literature search was conducted on PubMed, SCOPUS, and EuropePMC up to July 2, 2024. The primary outcome of this study was major adverse cardio-cerebrovascular events (MACCE), defined as a composite of mortality, stroke/systemic embolism, heart failure hospitalization (HFH), and acute coronary syndrome (ACS) during the follow-up period. Outcome measures were adjusted hazard ratios (aHR).

Results

A total of 504,124 patients from 11 studies were included in this systematic review and meta-analysis. Early rhythm control was significantly associated with reduction in MACCE (aHR 0.85 [95 % CI 0.80, 0.90], p < 0.001; I²: 23 %), stroke (aHR 0.79 [95 % CI 0.72, 0.86], p < 0.001; I²: 25 %), HFH (aHR 0.87 [95 % CI 0.78, 0.96], p = 0.008; I²: 48 %), and ACS (aHR 0.80 [95 % CI 0.66, 0.96], p = 0.018; I²: 40 %). No mortality benefit (aHR 0.93 [95 % CI 0.85, 1.01], p = 0.066; I²: 67 %) was observed; however, mortality benefit became evident (aHR 0.87 [95 % CI 0.85, 0.89], p < 0.001) upon removal of a study during a leave-one-out sensitivity analysis. Meta-regression analysis showed that the benefits of early rhythm control in terms of MACCE were more pronounced with ablation (coefficient −0.004, p = 0.010, R²: 100 %).

Conclusion

Early rhythm control was associated with better outcomes compared to rate control in AF, with a more pronounced benefit observed for ablation.

查看原文本刊更多论文

早期心律控制与房颤率控制的比较——系统回顾、meta分析和meta回归。

背景：本荟萃分析旨在比较早期心律控制与心率控制的有效性，以及导管消融是否比其他心律控制方法获得更多益处。方法：综合检索PubMed、SCOPUS、EuropePMC截止到2024年7月2日的文献。本研究的主要结局是主要心脑血管不良事件（MACCE），定义为随访期间死亡率、中风/全身栓塞、心力衰竭住院（HFH）和急性冠状动脉综合征（ACS）的复合。结果测量采用校正风险比（aHR）。结果：来自11项研究的504,124名患者被纳入本系统综述和荟萃分析。早期心律控制与MACCE降低显著相关(aHR 0.85 [95% CI 0.80, 0.90], p < 0.001；I2: 23%)，卒中(aHR 0.79 [95% CI 0.72, 0.86], p < 0.001；I2: 25%), HFH (aHR 0.87 [95% CI 0.78, 0.96], p = 0.008；I2: 48%)和ACS (aHR 0.80 [95% CI 0.66, 0.96], p = 0.018；I2: 40%)。无死亡率获益(aHR 0.93 [95% CI 0.85, 1.01], p = 0.066；I2: 67%)；然而，在留一敏感性分析中删除一项研究后，死亡率获益变得明显（aHR 0.87 [95% CI 0.85, 0.89], p < 0.001）。meta回归分析显示，早期心律控制在MACCE方面的益处在消融中更为明显（系数-0.004,p = 0.010, R2: 100%）。结论：与房颤的心率控制相比，早期心律控制与更好的预后相关，消融治疗的益处更明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Pacing and Electrophysiology Journal Medicine-Cardiology and Cardiovascular Medicine

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

61 days

期刊介绍： Indian Pacing and Electrophysiology Journal is a peer reviewed online journal devoted to cardiac pacing and electrophysiology. Editorial Advisory Board includes eminent personalities in the field of cardiac pacing and electrophysiology from Asia, Australia, Europe and North America.