Hybrid ablation for persistent/long-standing persistent atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials.

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2025-01-01 Epub Date: 2024-06-21 DOI:10.1007/s10840-024-01839-2

André Rivera, Marcelo Antonio Pinheiro Braga, Caique M P Ternes, Douglas Mesadri Gewehr, Felipe Villa Martignoni, Alexander Dal Forno, Andrew H Locke, André d'Avila

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Abstract

The efficacy and safety of hybrid ablation (HA) for patients with non-paroxysmal atrial fibrillation (AF) remain unclear. PubMed, Embase, Cochrane, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) comparing HA (endo-epicardial ablation) versus endocardial ablation (EA) for patients with persistent/long-standing persistent AF. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled. Our meta-analysis included 3 RCTs comprising 358 patients, of whom 233 (65.1%) were randomized to HA. Compared with EA, HA reduced the recurrence of atrial tachyarrhythmias (RR 0.53; 95% CI 0.41-0.69; p < 0.01) but had no subgroup interaction according to AF type (p = 0.90). There was no significant difference in major adverse events (RR 1.22; 95% CI 0.46-3.25; p = 0.68). Trial sequential analysis indicates that the observed effects can be deemed conclusive. In conclusion, in patients with persistent/long-standing persistent AF, HA substantially reduced the recurrence of atrial tachyarrhythmias. Notably, patients with long-standing persistent AF may benefit more from this ablation strategy.

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针对持续性/长期持续性心房颤动的混合消融术：随机对照试验的荟萃分析和试验顺序分析。

混合消融术（HA）对非阵发性房颤（AF）患者的疗效和安全性仍不明确。我们在 PubMed、Embase、Cochrane 和 ClinicalTrials.gov 等网站上检索了对持续/长期存在的房颤患者进行 HA（心内膜消融）与心内膜消融（EA）比较的随机对照试验（RCT）。对风险比 (RR) 和 95% 置信区间 (CI) 进行了汇总。我们的荟萃分析纳入了 3 项研究，共 358 名患者，其中 233 人（65.1%）随机接受了 HA 治疗。与 EA 相比，HA 降低了房性快速性心律失常的复发率（RR 0.53; 95% CI 0.41-0.69; p

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.