抗心律失常药物或导管消融治疗植入式心律转复除颤器患者室性心动过速:随机对照试验的系统回顾和荟萃分析。

Circulation: Arrhythmia and Electrophysiology Pub Date : 2019-11-01 DOI:10.1161/CIRCEP.119.007600

B. Kheiri, Mahmoud Barbarawi, Yazan Zayed, Michael Hicks, M. Osman, L. Rashdan, H. Kyi, Ghassan Bachuwa, Mustafa Hassan, E. Stecker, B. Nazer, Deepak L. Bhatt

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引用次数: 17

摘要

背景:在植入心脏转复除颤器(ICD)的患者中，电击与发病率和死亡率增加有关。因此，我们进行了这项研究，以评估抗心律失常药物和导管消融(CA)治疗室性心动过速(VT)的有效性和安全性。方法对评价ICD患者抗心律失常药物和CA的随机对照试验进行电子数据库检索。主要结局是复发性室性心动过速。次要结局是ICD电击和任何死亡。采用贝叶斯和频率网络元分析计算风险比(hr)和95%可信区间(CrIs)/ ci。结果共纳入22项随机对照试验(共3828例患者;64.3±11.4岁;79%的男性)。与对照组相比，使用胺碘酮可显著降低室速复发率(HR=0.34 [95% CrI=0.15-0.74];绝对风险差=-0.23 [95% CrI=-0.23 ~ -0.09];治疗人数=4)。与胺碘酮相比，索他洛尔与室速复发风险增加相关(HR=2.88 [95% CrI=1.35-6.46])。与对照组相比，胺碘酮组(HR=0.33 [95% CrI=0.15 ~ 0.76];绝对风险差=-0.17 [95% CrI=-0.32 ~ -0.06];需要治疗的人数=6)和CA (HR=0.52 [95% CrI=0.30-0.89;绝对风险差=-0.12 [95% CrI=-0.24 ~ -0.03];需要治疗的人数=8)与显著减少ICD休克相关。与胺碘酮相比，索他洛尔与ICD冲击显著增加相关(HR=2.70 [95% CrI=1.17-6.71])。两种竞争策略之间的死亡率无显著差异。节点分裂方法不存在不一致性。结论在ICD患者中，胺碘酮可显著降低室速复发和ICD冲击，而CA可显著降低ICD冲击。与胺碘酮相比，索他洛尔显著增加VT复发和ICD休克。胺碘酮的长期副作用和CA的早期并发症应根据患者的具体特点仔细权衡。

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Antiarrhythmic Drugs or Catheter Ablation in the Management of Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND In patients with an implantable cardioverter-defibrillator (ICD), shocks are associated with increased morbidity and mortality. Therefore, we conducted this study to evaluate the efficacy and safety of antiarrhythmic drugs and catheter ablation (CA) in the treatment of ventricular tachyarrhythmias (VT) in patients with an ICD. METHODS An electronic database search for randomized controlled trials that evaluated antiarrhythmic drugs and CA in patients with ICD was conducted. The primary outcome was recurrent VT. Secondary outcomes were ICD shocks and any deaths. Bayesian and frequentist network meta-analyses were performed to calculate hazard ratios (HRs) and 95% credible intervals (CrIs)/CIs. RESULTS Twenty-two randomized controlled trials were identified (3828 total patients; age 64.3±11.4; 79% males). The use of amiodarone was associated with a significantly reduced rate of VT recurrence compared with control (HR=0.34 [95% CrI=0.15-0.74]; absolute risk difference=-0.23 [95% CrI=-0.23 to -0.09]; number needed to treat=4). Sotalol was associated with increased risk of VT recurrence compared with amiodarone (HR=2.88 [95% CrI=1.35-6.46]). Compared with control, amiodarone (HR=0.33 [95% CrI=0.15-0.76]; absolute risk difference=-0.17 [95% CrI=-0.32 to -0.06]; number needed to treat=6) and CA (HR=0.52 [95% CrI=0.30-0.89; absolute risk difference=-0.12 [95% CrI=-0.24 to -0.03]; number needed to treat=8) were associated with significantly reduced ICD shocks. Compared with amiodarone, sotalol was associated with significantly increased ICD shocks (HR=2.70 [95% CrI=1.17-6.71]). The rate of death was not significantly different between the competing strategies. The node-splitting method showed no inconsistency. CONCLUSIONS Among patients with an ICD, amiodarone significantly reduced VT recurrence and ICD shocks, while CA reduced ICD shocks. Sotalol significantly increased VT recurrence and ICD shocks compared with amiodarone. The long-term side effects of amiodarone and early complications of CA should be weighed carefully according to specific patient characteristics.

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Circulation: Arrhythmia and Electrophysiology

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