目的 探讨导管消融术(CA)治疗肥厚型心肌病(HCM)合并心房纤颤(AF)的长期结果、临床疗效及安全性,总结复发性心律失常的预测因素。方法 检索2013-01至2022-01纳入Pubmed、CNKI、NOS等电子数据库检索符合标准的18篇HCM合并AF患者进行CA术后的文献,利用Revman软件进行Meta分析,总结CA成功率、不良反应及并发症,评估CA对HCM伴AF临床疗效、长期结果及安全性。结果 HCM合并AF患者826例经CA治疗,停止口服药物后随访,Meta分析示,临床观察转复率69.98%,95%CI:1.99(1.72,2.30),P<0.00001。围手术期及术后并发症共64例,95%CI为0.09(0.08,0.10),P<0.00001。在HCM合并AF患者中行CA转复成功率高,能有效转复为窦性心律,部分患者在口服降心率药物的协助下能维持窦性心律。CA术后预测复发/成功的协变量为左心房直径(LAD)、左室射血分数(LVEF)。结论 CA治疗HCM合并AF转复率高,临床效果显著,并发症少,病死率低,安全性好,LAD和左房容积指数是CA术后AF复发的最重要因素。
Abstract
Objective To investigate the long-term outcome, clinical efficacy, and safety of catheter ablation (CA) in the treatment of hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF) and to summarize the predictive factors of recurrent arrhythmias. Methods The retrieval time was from January 2013 to January 2022. A total of 18 literatures meeting the criteria for CA postoperative in patients with HCM and AF were included in Pubmed, CNKI, NOS and other electronic databases. Meta-analysis was performed using Revman software to summarize the success rate of CA, adverse reactions and complications. To evaluate the clinical efficacy, long-term outcome and safety of CA in HCM with AF. Results A total of 826 patients with HCM complicated with AF were treated with CA and followed up after discontinuation of oral medication. Meta-analysis showed that the clinical observation recovery rate was 69.98%, 95%CI: 1.99 (1.72,2.30), P<0.00001. 64 patients underwent surgery and complications. 95%CI was 0.09 (0.08,0.10), P<0.00001. The success rate of CA conversion in HCM patients with AF is high, which can effectively convert to sinus rhythm. Some patients can maintain sinus rhythm with the assistance of oral heart-rate lowering drugs. The covariates predicting recurrence/success after CA surgery were left atrial diameter(LAD)and left ventricular ejection fraction(LVEF). Conclusions CA in the treatment of HCM combined with AF has a high recurrence rate, significant clinical effect, fewer complications, low mortality, and good safety. LAD and left atrial volume index are the most important factors for AF recurrence after CA.
关键词
肥厚型心肌病 /
心房纤颤 /
导管消融 /
临床疗效 /
荟萃分析
Key words
hypertrophic myocardium /
atrial fibrillation /
catheter ablation /
clinical efficacy /
Meta-analysis
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基金
国家重点研发计划“主动健康和老龄化科技应对”重点专项(2021YFC2009300)
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