摘要
目的系统评价导管消融治疗持续性心房颤动合并心力衰竭的疗效。方法系统检索PubMed、Cochrane图书馆、Embase、ClinicalTrials. gov、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)以及万方数据库,筛选并纳入采用导管消融与室率控制治疗持续性心房颤动合并心力衰竭疗效比较的试验,应用Revman 5. 3软件进行Meta分析。结果共入选5项研究,累计有423例患者,其中214例接受导管消融治疗。Meta分析结果显示,导管消融术后左心室射血分数(left ventricular ejection fraction,LVEF)显著升高,MD为5. 21%(95%CI:1. 69～8. 73,P=0. 004),但研究间存在显著异质性(I^2=80%,P=0. 000 6)。经调整纳入测量指标,行敏感性分析排除异质性来源之后,重新纳入软件进行Meta分析,文献间未发现异质性(I^2=0%,P=0. 49),此时LVEF的MD变为7. 31%(95%CI:5. 18～9. 45,P <0. 000 01)。同时,对导管消融治疗前后明尼苏达心功能不全生命质量量表、6 min步行距离、峰值耗氧量、脑钠肽、NHYA心功能分级的变化进行分析,与室率控制治疗相比,亦有明显改善。结论导管消融与室率控制治疗持续性房颤合并心力衰竭的疗效相比,前者改善持续性房颤合并心力衰竭患者的LVEF、心功能、运动能力和生活质量的趋势更明显,但更确切的疗效有待进一步研究。
Objective To make systematic evaluation on the efficacy of catheter ablation in treating the patients with persistent atrial fibrillation(PAF) complicating heart failure(HF).Methods After systematic search in PubMed, Cochrane Library, Embase, Clinical Trials. gov, CNKI, CBM and Wanfang Database, we screened out the experiments related to comparison between the efficacy of catheter ablation and ventricular rate control in treating PAF complicating HF, and adopted them in our study. Meta analysis was performed with the software of Revman 5.3. Results We retrieved and summarized 5 randomized controlled trials, enrolling 423 patients (214 accepting the treatment of catheter ablation). Meta analysis results showed that left ventricular ejection fraction(LVEF) significantly increased after catheter ablation and MD was 5.21%(95% CI : 1.69- 8.73, P =0.004). However, obvious heterogenicity existed among different studies( I^2=80%, P =0.0006). The measurement indexes were adjusted with heterogeneous sources excluded by sensitivity analysis before being readopted into the software for Meta analysis. No heterogenicity was found among the related literatures( I^2=0%, P =0.49), and at present the MD of LVEF became 7.31%(95% CI :5.18-9.45, P <0.000 01). Simultaneously, changes of MLHFQ, 6MWT, BNP, Peak VO 2 and NHYA Class were analyzed before and after the treatment. These indexes also significantly improved if compared with those in the treatment of ventricular rate control. Conclusion Compared with the treatment of ventricular rate control, catheter ablation shows a tendency of improving LVEF, heart function, kinetism and life quality in the patients with PAF and HF, however, its specific efficacy requires for further research.
作者
尹春娥
王福军
周芳
Yin Chun-e;Wang Fu-jun;Zhou Fang(Department of No.2 Cardiology, Xiangxi Tujia Miao Autonomous Prefecture People s Hospital, the First Affiliated Hospital of Jishou University, Jishou Hunan 416000, China)
出处
《实用心电学杂志》
2019年第1期42-48,共7页
Journal of Practical Electrocardiology
关键词
导管消融
心房颤动
心力衰竭
左心室射血分数
生活质量
系统评价
catheter ablation
atrial fibrillation
heart failure
left ventricular ejection fraction
life quality
systematic evaluation
