Surgical ablation of atrial fibrillation: a systematic review andmeta-analysis of randomized controlled trials

被引:55
作者
McClure, Graham R. [1 ,2 ]
Belley-Cote, Emilie P. [2 ,3 ,4 ,5 ]
Jaffer, Iqbal H. [6 ,7 ]
Dvirnik, Nazari [2 ,4 ,7 ]
An, Kevin R. [1 ]
Fortin, Gabriel [5 ]
Spence, Jessica [2 ,8 ]
Healey, Jeff [3 ,4 ]
Singal, Rohit K. [9 ,10 ]
Whitlock, Richard P. [2 ,4 ,7 ]
机构
[1] McMaster Univ, Michael G DeGroote Sch Med, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
[2] McMaster Univ, Dept Clin Epidemiol & Biostat, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
[3] McMaster Univ, Dept Med, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
[4] Populat Hlth Res Inst, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
[5] Univ Sherbrooke, Dept Med, 2500 Blvd Univ, Sherbrooke, PQ J1K 2R1, Canada
[6] McMaster Univ, Thrombosis & Atherosclerosis Res Inst TaARI, 20 Copeland Ave, Hamilton, ON L8L 2X2, Canada
[7] McMaster Univ, Dept Cardiac Surg, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
[8] McMaster Univ, Dept Anesthesia, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
[9] Univ Manitoba, Dept Surg, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada
[10] St Boniface Gen Hosp, IH Asper Clin Res Inst, 69 Tache Ave, Winnipeg, MB R2H 2A6, Canada
来源
EUROPACE | 2018年 / 20卷 / 09期
关键词
Surgical ablation; Atrial fibrillation; Maze operation; Pulmonary vein isolation; Meta-analysis; TIP RADIOFREQUENCY ABLATION; VALVULAR HEART-DISEASE; MITRAL-VALVE SURGERY; MAZE PROCEDURE; RHYTHM CONTROL; PERMANENT; PREDICTORS; EXPERIENCE; EFFICACY; RISK;
D O I
10.1093/europace/eux336
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims The aim of this review was to assess the effect of concomitant surgical atrial fibrillation (AF) ablation on postoperative freedom from AF and patient-important outcomes. Methods and results We searched Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016 for randomized controlled trials (RCTs) evaluating surgical AF ablation using any lesion set vs. no surgical AF ablation in adults with AF undergoing cardiac surgery. We performed screening, risk-of-bias evaluation, and data collection independently and in duplicate. We evaluated risk of bias with the modified Cochrane tool, quality of evidence using GRADE framework, and pooled data with a random-effects model. Of the 23 included studies, only one was considered at low risk of bias. Surgical AF ablation was associated with more freedom from AF at 12 months [relative risk (RR) = 2.32, 95% confidence interval (CI) 1.92-2.80; P < 0.001, low quality]. However, no significant difference was seen in mortality (RR = 1.07, 95% CI 0.72-1.52; P = 0.41, moderate quality), stroke (RR = 1.19, 95% CI 0.59-2.39; P = 0.63, moderate quality), or pacemaker implantation (RR = 1.28, 95% CI 0.85-1.95; P = 0.24, high quality). Comparing biatrial and left-sided lesion sets showed no difference in mortality (P-interaction = 0.60) or stroke (P-interaction = 0.12). At 12 months, biatrial procedures led to more freedom from AF (RR = 2.80, 95% CI 2.13-3.68; P < 0.0001) when compared with left-sided ablation (RR = 2.00, 95% CI 1.68-2.39; P < 0.0001) (P-interaction = 0.04) Biatrial procedures appear to increase the risk for pacemaker (RR = 2.68, 95% CI 1.41-5.11; P = 0.002) compared with no ablation while left-sided ablation does not (RR = 1.08, 95% CI 0.67-1.74; P = 0.76) (P-interaction = 0.03). Conclusion Surgical AF ablation during cardiac surgery improves freedom from AF. However, impact on patient-important outcomes including mortality and stroke has not shown statistical significance in current RCT evidence. Biatrial compared with left-sided lesion sets showed no difference in mortality or stroke but were associated with significantly increased freedom from AF and risk for pacemaker requirement.
引用
收藏
页码:1442 / 1450
页数:9
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