Hosam I. Taha, Abubakar Nazir, Ahmed A. Ibrahim, Mohamed S. Elgendy, Abdalhakim Shubietah, Hazem Reyad Mansour, Sherif Sary, Moataz Maged, Mustafa Turkmani, Mohamed Abuelazm
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引用次数: 0
摘要
目的直流电复心术（DCCV）是房颤治疗的常用手段，但活动性胸外按压是否能提高其疗效尚不确定。本荟萃分析评估了主动压缩对心律转复结果的影响。方法综合PubMed、Scopus、WOS、Embase和Cochrane图书馆截至2024年9月的随机对照试验（RCTs）的证据，进行系统评价和荟萃分析。采用R软件（4.3.1版）进行统计分析，二分类结局采用风险比（RR），连续结局采用平均差异（MD）， 95%置信区间（CI）。普洛斯彼罗id: crd42024595499。结果纳入4项随机对照试验，共纳入737例患者。与无压缩入路相比，DCCV期间主动压缩与转复成功率无显著差异(RR: 1.10；95% CI [0.96, 1.25], p = 0.16)，首次休克成功(RR: 1.62；95% CI [0.94, 2.81], p = 0.08)，冲击次数(MD: -0.32；95% CI[−1.01,0.36],p = 0.36)或交叉成功(MD: 0.76；95% CI [0.33, 1.77], p = 0.52)。然而，主动压缩与成功冲击能量降低相关(MD: -23.97 J；95% CI[−26.84,−21.10],p < 0.01)。结论DCCV过程中主动按压不能显著提高心律转复成功率，但可能降低心律转复成功所需的能量，提示有潜在的安全性。然而，需要进一步的研究来确定其临床意义。
Active Compression During External Cardioversion of Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials
Objectives
Direct current cardioversion (DCCV) is commonly used for atrial fibrillation, but there is uncertainty about whether active chest compression improves its effectiveness. This meta-analysis evaluates the impact of active compression on cardioversion outcomes.
Methods
A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and Cochrane Library till September 2024. Statistical analysis was performed using R software (version 4.3.1), applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). PROSPERO ID: CRD42024595499.
Results
Four RCTs with 737 patients were included. When compared to the no-compression approach, active compression during DCCV was not associated with any significant difference in cardioversion success (RR: 1.10; 95% CI [0.96, 1.25], p = 0.16), first shock success (RR: 1.62; 95% CI [0.94, 2.81], p = 0.08), number of shocks (MD: -0.32; 95% CI [−1.01, 0.36], p = 0.36), or crossover success (MD: 0.76; 95% CI [0.33, 1.77], p = 0.52). However, active compression was associated with a reduced successful shock energy (MD: -23.97 J; 95% CI [−26.84, −21.10], p < 0.01).
Conclusion
Active compression during DCCV does not significantly improve cardioversion success but may reduce the energy required for successful cardioversion, suggesting potential safety benefits. However, further studies are needed to determine its clinical relevance.
期刊介绍：
The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients.
ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation.
ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.
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