Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis

医学 心房颤动 内科学 心脏病学 导管消融 置信区间 荟萃分析 相对风险 心耳 烧蚀 冲程(发动机) 窦性心律 机械工程 工程类
作者
Jorge Romero,Gregory F. Michaud,Ricardo Avendaño,David Briceño,Saurabh Kumar,Juan Carlos Díaz,Sanghamitra Mohanty,Chintan Trivedi,Carola Gianni,Domenico Della Rocca,Riccardo Proietti,Laura Perrotta,Stefano Bordignon,Julian K R Chun,Boris Schmidt,Mario J. García,Andrea Natale,Luigi Di Biase
出处
期刊:Europace [Oxford University Press]
卷期号:20 (8): 1268-1278 被引量:61
标识
DOI:10.1093/europace/eux372
摘要

The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69%]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5% vs. 43.9% in those in whom only standard ablation was performed [56% relative reduction and 31.6% absolute reduction; risk ratio (RR) 0.44, 95% confidence interval (95% CI) 0.31–0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow-up (RR 0.40, 95% CI 0.12–1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, control 5.5% (RR 0.99, 95% CI 0.46–2.16; P = 0.99)]. Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke.
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