镇静与全身麻醉消融室性心律失常:系统回顾和荟萃分析。

IF 1.3 Q3 ANESTHESIOLOGY
Annals of Cardiac Anaesthesia Pub Date : 2025-04-01 Epub Date: 2025-04-16 DOI:10.4103/aca.aca_229_24
Shubh Patel, Jiawen Deng, Areeba Zubair, Kiyan Heybati, Shayan Heybati, Oswin Chang, Umaima Abbas, Umair Tahir, Harikrishnaa B Ramaraju, Chi Y Wong, Thanansayan Dhivagaran, Daniel Rayner, Magnus Krever, Tiffany Woelber, Gurukripa N Kowlgi, Harish Ramakrishna
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引用次数: 0

摘要

摘要:室性心律失常(VA),包括室性心动过速和纤颤,是一种危重的心脏疾病,在对药物治疗无反应的患者中,通常采用导管消融治疗。VA消融的麻醉和镇静方案的选择可能影响心律失常的诱发性和血流动力学稳定性,从而影响手术成功率和并发症发生率。本系统综述和荟萃分析旨在比较镇静与全身麻醉(GA)在VA消融患者中的疗效和安全性。该综述在PROSPERO (CRD42023441553)进行了前瞻性注册。从建立到2024年3月9日,在五个主要数据库中进行数据库检索,以确定随机试验或观察性研究,包括接受VA消融的成年患者。筛选和数据提取一式两份完成。由于所有纳入的研究均为观察性研究,因此使用ROBINS-I进行偏倚风险评估,并使用GRADE框架评估证据质量。纳入6项观察性研究(N = 16,435)。镇静和GA在总手术时间上无显著差异(MD: -14.16分钟;95%CI: -38.61 ~ 10.29 min)、心律失常不可诱发性(RR: 0.73;95% CI: 0.33-1.58),急性消融成功(RR: 1.06;95% CI: 0.65-1.71)或手术并发症(RR: 0.72;95% ci: 0.28-1.85)。然而,镇静与术中血流动力学不稳定性显著降低相关(RR: 0.28;95% ci: 0.12-0.70)。这些发现表明,虽然镇静和GA具有相似的结果,镇静可能与心室消融术中较少的血流动力学不稳定性有关。然而,需要更多高质量的研究来证实这些结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sedation Versus General Anesthesia for Ablation of Ventricular Arrhythmias: A Systematic Review and Meta-Analysis.

Abstract: Ventricular arrhythmias (VA), including ventricular tachycardia and fibrillation, are critical cardiac conditions that are often managed by catheter ablation among those unresponsive to pharmacologic therapy. The choice of anesthesia and sedation regimens for VA ablations may impact arrhythmia inducibility and hemodynamic stability, which can affect procedural success and complication rates. This systematic review and meta-analysis aimed to compare the efficacy and safety of sedation versus general anesthesia (GA) among patients undergoing VA ablation. The review was prospectively registered on PROSPERO (CRD42023441553). Database searches were conducted across five major databases from inception to March 9, 2024 to identify randomized trials or observational studies including adult patients undergoing ablations for VA. Screening and data extraction were completed in duplicate. Risk-of-bias assessments were conducted using ROBINS-I as all included studies were observational, and the quality of evidence was evaluated using the GRADE framework. Six observational studies (N = 16,435) were included. No significant differences were found between sedation and GA for total procedure time (MD: -14.16 minutes; 95%CI: -38.61 to 10.29 minutes), arrhythmia non-inducibility (RR: 0.73; 95% CI: 0.33-1.58), acute ablation success (RR: 1.06; 95% CI: 0.65-1.71), or procedural complications (RR: 0.72; 95% CI: 0.28-1.85). However, sedation was associated with significantly lower intraprocedural hemodynamic instability (RR: 0.28; 95% CI: 0.12-0.70). These findings indicate that while sedation and GA have comparable outcomes, sedation may be associated with less hemodynamic instability during VA ablation. However, more high-quality studies are needed to confirm these results.

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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
147
审稿时长
26 weeks
期刊介绍: Annals of Cardiac Anaesthesia (ACA) is the official journal of the Indian Association of Cardiovascular Thoracic Anaesthesiologists. The journal is indexed with PubMed/MEDLINE, Excerpta Medica/EMBASE, IndMed and MedInd. The journal’s full text is online at www.annals.in. With the aim of faster and better dissemination of knowledge, we will be publishing articles ‘Ahead of Print’ immediately on acceptance. In addition, the journal would allow free access (Open Access) to its contents, which is likely to attract more readers and citations to articles published in ACA. Authors do not have to pay for submission, processing or publication of articles in ACA.
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