{"title":"左心房 BOX 消融术治疗持续性心房颤动的安全性和有效性：元分析。","authors":"Yang Li, Yin Xi, Wenyu Zhang, Jie Hao","doi":"10.31083/j.rcm2509316","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Circumferential pulmonary vein isolation (CPVI) has a high recurrence rate in managing persistent atrial fibrillation (AF). While some studies suggest that augmenting CPVI with additional left atrial BOX ablation can diminish this recurrence rate among patients with persistent AF, this approach remains controversial. This meta-analysis assesses the safety and efficacy of adjunctive left atrial BOX ablation in treating persistent atrial fibrillation.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search across China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and Cochrane Library, focusing on randomized controlled trials. The primary outcome was the recurrence rate of any atrial arrhythmias (AAs) within one-year post-treatment, with the secondary outcome being the frequency of adverse events related to the surgery.</p><p><strong>Results: </strong>The combination of CPVI and left atrial BOX ablation did not lead to a significant reduction in the overall recurrence rate of atrial arrhythmias (risk ratios (RR) = 0.86, 95% confidence interval (CI) = 0.73-1.02, I<sup>2</sup> = 35%). However, subgroup analyses revealed that this therapeutic approach significantly decreased the recurrence rates of all atrial arrhythmias (RR = 0.67, 95% CI = 0.49-0.92, I<sup>2</sup> = 15%) and specifically atrial fibrillation (RR = 0.53, 95% CI = 0.37-0.77, I<sup>2</sup> = 0%) in patients with a left atrial diameter ≤44 mm. Notably, there was no significant increase in the incidence of procedure-related adverse events (RR = 1.04, 95% CI = 0.56-1.94, I<sup>2</sup> = 0%). However, the durations of both the ablation (mean difference (MD) = 19.77, 95% CI = 15.84-23.70, I<sup>2</sup> = 0%) and the overall procedure (MD = 15.64, 95% CI = 6.99-24.29, I<sup>2</sup> = 0%) were longer due to the additional ablation steps.</p><p><strong>Conclusions: </strong>In patients with smaller left atrial diameters, augmenting CPVI with left atrial BOX ablation significantly lowers the recurrence rates of atrial arrhythmias and atrial fibrillation without elevating surgical risk levels.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 9","pages":"316"},"PeriodicalIF":1.9000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440413/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Safety and Efficacy of Left Atrial BOX Ablation in Persistent Atrial Fibrillation: A Meta-Analysis.\",\"authors\":\"Yang Li, Yin Xi, Wenyu Zhang, Jie Hao\",\"doi\":\"10.31083/j.rcm2509316\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Circumferential pulmonary vein isolation (CPVI) has a high recurrence rate in managing persistent atrial fibrillation (AF). While some studies suggest that augmenting CPVI with additional left atrial BOX ablation can diminish this recurrence rate among patients with persistent AF, this approach remains controversial. This meta-analysis assesses the safety and efficacy of adjunctive left atrial BOX ablation in treating persistent atrial fibrillation.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search across China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and Cochrane Library, focusing on randomized controlled trials. The primary outcome was the recurrence rate of any atrial arrhythmias (AAs) within one-year post-treatment, with the secondary outcome being the frequency of adverse events related to the surgery.</p><p><strong>Results: </strong>The combination of CPVI and left atrial BOX ablation did not lead to a significant reduction in the overall recurrence rate of atrial arrhythmias (risk ratios (RR) = 0.86, 95% confidence interval (CI) = 0.73-1.02, I<sup>2</sup> = 35%). However, subgroup analyses revealed that this therapeutic approach significantly decreased the recurrence rates of all atrial arrhythmias (RR = 0.67, 95% CI = 0.49-0.92, I<sup>2</sup> = 15%) and specifically atrial fibrillation (RR = 0.53, 95% CI = 0.37-0.77, I<sup>2</sup> = 0%) in patients with a left atrial diameter ≤44 mm. Notably, there was no significant increase in the incidence of procedure-related adverse events (RR = 1.04, 95% CI = 0.56-1.94, I<sup>2</sup> = 0%). However, the durations of both the ablation (mean difference (MD) = 19.77, 95% CI = 15.84-23.70, I<sup>2</sup> = 0%) and the overall procedure (MD = 15.64, 95% CI = 6.99-24.29, I<sup>2</sup> = 0%) were longer due to the additional ablation steps.</p><p><strong>Conclusions: </strong>In patients with smaller left atrial diameters, augmenting CPVI with left atrial BOX ablation significantly lowers the recurrence rates of atrial arrhythmias and atrial fibrillation without elevating surgical risk levels.</p>\",\"PeriodicalId\":20989,\"journal\":{\"name\":\"Reviews in cardiovascular medicine\",\"volume\":\"25 9\",\"pages\":\"316\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440413/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reviews in cardiovascular medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.31083/j.rcm2509316\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reviews in cardiovascular medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.31083/j.rcm2509316","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：环形肺静脉隔离术（CPVI）在治疗持续性房颤（AF）时复发率较高。虽然一些研究表明，在 CPVI 的基础上增加左心房 BOX 消融术可以降低持续性房颤患者的复发率，但这种方法仍存在争议。本荟萃分析评估了辅助左心房BOX消融术治疗持续性房颤的安全性和有效性：我们在中国国家知识基础设施（CNKI）、PubMed、Web of Science 和 Cochrane 图书馆进行了全面的文献检索，重点关注随机对照试验。主要结果是治疗后一年内任何房性心律失常（AAs）的复发率，次要结果是手术相关不良事件的发生频率：结果：CPVI和左心房BOX消融术的联合应用并未显著降低房性心律失常的总体复发率（风险比（RR）=0.86，95%置信区间（CI）=0.73-1.02，I2=35%）。然而，亚组分析显示，在左心房直径≤44 毫米的患者中，这种治疗方法显著降低了所有房性心律失常的复发率（RR = 0.67，95% CI = 0.49-0.92，I2 = 15%），特别是房颤的复发率（RR = 0.53，95% CI = 0.37-0.77，I2 = 0%）。值得注意的是，手术相关不良事件的发生率没有明显增加（RR = 1.04，95% CI = 0.56-1.94，I2 = 0%）。然而，由于增加了消融步骤，消融时间（平均差 (MD) = 19.77，95% CI = 15.84-23.70，I2 = 0%）和整个手术时间（MD = 15.64，95% CI = 6.99-24.29，I2 = 0%）都延长了：结论：对于左心房直径较小的患者，通过左心房BOX消融术增强CPVI可显著降低房性心律失常和心房颤动的复发率，且不会提高手术风险水平。
The Safety and Efficacy of Left Atrial BOX Ablation in Persistent Atrial Fibrillation: A Meta-Analysis.
Background: Circumferential pulmonary vein isolation (CPVI) has a high recurrence rate in managing persistent atrial fibrillation (AF). While some studies suggest that augmenting CPVI with additional left atrial BOX ablation can diminish this recurrence rate among patients with persistent AF, this approach remains controversial. This meta-analysis assesses the safety and efficacy of adjunctive left atrial BOX ablation in treating persistent atrial fibrillation.
Methods: We conducted a comprehensive literature search across China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and Cochrane Library, focusing on randomized controlled trials. The primary outcome was the recurrence rate of any atrial arrhythmias (AAs) within one-year post-treatment, with the secondary outcome being the frequency of adverse events related to the surgery.
Results: The combination of CPVI and left atrial BOX ablation did not lead to a significant reduction in the overall recurrence rate of atrial arrhythmias (risk ratios (RR) = 0.86, 95% confidence interval (CI) = 0.73-1.02, I2 = 35%). However, subgroup analyses revealed that this therapeutic approach significantly decreased the recurrence rates of all atrial arrhythmias (RR = 0.67, 95% CI = 0.49-0.92, I2 = 15%) and specifically atrial fibrillation (RR = 0.53, 95% CI = 0.37-0.77, I2 = 0%) in patients with a left atrial diameter ≤44 mm. Notably, there was no significant increase in the incidence of procedure-related adverse events (RR = 1.04, 95% CI = 0.56-1.94, I2 = 0%). However, the durations of both the ablation (mean difference (MD) = 19.77, 95% CI = 15.84-23.70, I2 = 0%) and the overall procedure (MD = 15.64, 95% CI = 6.99-24.29, I2 = 0%) were longer due to the additional ablation steps.
Conclusions: In patients with smaller left atrial diameters, augmenting CPVI with left atrial BOX ablation significantly lowers the recurrence rates of atrial arrhythmias and atrial fibrillation without elevating surgical risk levels.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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