主动脉瓣置换术并发心房颤动消融：系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-07-01 DOI:10.1016/j.cjco.2025.05.001

Emre Polat MD , Rohit K. Kharbanda MD, PhD , Moustafa Ghafar BSc , Jan W. Schoones MA , Robert J.M. Klautz MD, PhD , Marta de Riva MD, PhD , Meindert Palmen MD, PhD , Evaldas Girdauskas MD , Anton Tomšič MD, PhD

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引用次数: 0

摘要

背景：心房颤动（AF）在主动脉瓣置换术患者中很常见；然而，由于有关手术消融疗效的数据有限，其应用仍然不足。方法通过检索PubMed、Embase、Web of Science、Emcare和Cochrane图书馆，对报道主动脉瓣置换术患者并发房颤消融结果的文献进行系统综述。主要结局包括无房颤复发、总生存期和并发症。我们使用传统的meta分析分析特定时间点的结果，并结合Kaplan-Meier曲线。结果纳入9项研究，共12683例患者。联合消融降低了术后房颤的风险，但增加了永久性起搏器植入的风险(风险比1.36,95%可信区间[CI] 1.16-1.60, P <；0.01)和术后肾功能衰竭(RR 1.38, 95% CI 1.11-1.71, P <；0.01)。在随访期间，联合消融有效地恢复和维持了窦性心律，高达80%的患者在术后2-4年没有复发性房颤。此外，合并消融可改善晚期生存率（未校正风险比0.84,95% CI 0.73-0.96, P = 0.013）。结论主动脉瓣置换术中消融对恢复和维持术后窦性心律是有效的。术前心律状态可能在指导治疗计划中发挥重要作用，可能会提高计划进行主动脉瓣介入治疗的患者的临床结果。

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Concomitant Atrial Fibrillation Ablation in Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background

Atrial fibrillation (AF) is common in patients undergoing surgical aortic valve replacement; however, surgical ablation remains underused due to limited data on its efficacy.

Methods

We conducted a systematic review of the literature by searching PubMed, Embase, Web of Science, Emcare, and the Cochrane Library for studies reporting outcomes of concomitant surgical AF ablation in patients undergoing surgical aortic valve replacement. The primary outcomes included freedom from AF recurrence, overall survival, and complications. We analyzed outcomes using traditional meta-analysis at specific time points, alongside pooled Kaplan-Meier curves.

Results

Nine studies were included, encompassing a total of 12,683 patients. Concomitant ablation reduced the risk of postoperative AF but increased the risk of permanent pacemaker implantation (risk ratio 1.36, 95% confidence interval [CI] 1.16-1.60, P < 0.01) and postoperative renal failure (RR 1.38, 95% CI 1.11-1.71, P < 0.01). During follow-up, concomitant ablation effectively restored and maintained sinus rhythm, with up to 80% of patients remaining free from recurrent AF 2-4 years post-surgery. Moreover, improved late survival was observed with concomitant ablation (unadjusted hazard ratio 0.84, 95% CI 0.73-0.96, P = 0.013).

Conclusions

Surgical ablation during surgical aortic valve replacement was effective in restoring and maintaining sinus rhythm after surgery. Preoperative rhythm status may play an important role in guiding treatment plans, potentially enhancing the clinical outcomes for patients scheduled for aortic valve intervention.

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