Leo N Consoli, Eren Cetinel, Pawel Lajczak, Ilias G Koziakas, Mir Wajid Majeed, Prajna Wijaya, Issa Salha, George Samanidis
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We compared endpoints using risk ratio (RR) for binary and mean difference for continuous outcomes. We calculated 95% confidence intervals for all outcomes. We carried out a trial sequential analysis for primary (POAF) and secondary (hospital stay; complications) endpoints. We conducted meta-regression for all covariates with at least 10 observations.</p><p><strong>Results: </strong>We included 20 trials (n=3348). Seven studied anterior fat pad (AFP) preservation, 5 pulmonary vein isolation (PVI), 2 ganglionic plexus (GP) ablation, 1 partial cardiac denervation (PCD) and 5 assessed epicardial injections. POAF incidence was lower in the SNMT group (RR 0.62 (0.48; 0.79), p < 0.001), driven by the AFP preservation, PCD and PVI subgroups. Epicardial injections were only effective in patients undergoing coronary surgery. SNMTs also reduced hospital stay (p=0.03). All meta-regression analyses were insignificant. 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引用次数: 0
摘要
背景：术后心房颤动（POAF）在心脏手术后经常发生，并与死亡率增加有关。目的：外科神经调节疗法（SNMTs）作为一种预防策略已被探索，但其有效性和安全性仍不确定。方法：检索PubMed、Embase和Cochrane文库，寻找符合条件的随机对照试验。对初级（POAF）和次级(住院时间；并发症;房颤1年；操作时间;POAF负担;ICU住院)终点。对各技术进行亚组分析。我们使用风险比（RR）对二元终点和连续终点的平均差异进行比较。我们计算了所有结果的95%置信区间。我们对主要（POAF）和次要(住院时间；并发症)的端点。我们对所有至少有10个观察值的协变量进行了meta回归。结果：我们纳入了20项试验（n=3348）。7例研究前脂肪垫（AFP）保存，5例研究肺静脉隔离（PVI）， 2例研究神经节丛（GP）消融，1例研究心脏部分去神经（PCD）， 5例研究心外膜注射。SNMT组POAF发生率较低(RR 0.62；0.79), p < 0.001)，由AFP保存、PCD和PVI亚组驱动。心外膜注射仅对接受冠状动脉手术的患者有效。snmt也减少了住院时间（p=0.03）。所有meta回归分析均不显著。在试验序列分析中，观察到POAF的积极作用。结论：本荟萃分析发现，AFP保存、PCD和PVI的实施显著降低了POAF的发病率。心外膜注射仅对接受冠状动脉搭桥术的患者有效。
Surgical Neuromodulation Therapies to Prevent Postoperative Atrial Fibrillation: A Meta-Analysis, Meta Regression and Trial Sequential Analysis of Randomized Controlled Trials.
Background: Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased mortality.
Objectives: Surgical neuromodulation therapies (SNMTs) have been explored as a preventive strategy, but their efficacy and safety remain uncertain.
Methods: We searched PubMed, Embase and the Cochrane library for eligible randomized controlled trials. Meta-analysis was performed for primary (POAF) and secondary (hospital stay; complications; atrial fibrillation at 1 year; operation time; POAF burden; ICU stay) endpoints. Subgroup analysis was conducted for each technique. We compared endpoints using risk ratio (RR) for binary and mean difference for continuous outcomes. We calculated 95% confidence intervals for all outcomes. We carried out a trial sequential analysis for primary (POAF) and secondary (hospital stay; complications) endpoints. We conducted meta-regression for all covariates with at least 10 observations.
Results: We included 20 trials (n=3348). Seven studied anterior fat pad (AFP) preservation, 5 pulmonary vein isolation (PVI), 2 ganglionic plexus (GP) ablation, 1 partial cardiac denervation (PCD) and 5 assessed epicardial injections. POAF incidence was lower in the SNMT group (RR 0.62 (0.48; 0.79), p < 0.001), driven by the AFP preservation, PCD and PVI subgroups. Epicardial injections were only effective in patients undergoing coronary surgery. SNMTs also reduced hospital stay (p=0.03). All meta-regression analyses were insignificant. In the trial sequential analysis, a positive effect for POAF was observed.
Conclusions: This meta-analysis found a significant reduction in POAF incidence with implementation of AFP preservation, PCD and PVI. Epicardial injections were only effective for patients undergoing coronary bypass.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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