导管消融治疗心房颤动和神经系统疾病的风险

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Rhythm O2 Pub Date : 2025-01-01 Epub Date: 2024-11-09 DOI:10.1016/j.hroo.2024.11.004

Mohammed Al-Sadawi MBBCh, Nithi Tokavanich MD, Jasneet Devgun MD, Michael Ghannam MD, Rakesh Latchamsetty MD, Krit Jongsarangsin MD, Hakan Oral MD

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引用次数: 0

摘要

背景：心房颤动（AF）的导管消融（CA）已被证明对有症状的房颤（AF）和心力衰竭患者有益。然而，包括脑血管意外（CVA）和痴呆在内的神经系统预后数据仍存在争议。目的在长期随访中确定CA对神经系统事件的影响。方法我们对房颤患者进行了系统回顾和荟萃分析，并对MEDLINE、EMBASE和Web of Science数据库进行了全面检索，检索时间从成立到2024年1月。报道房颤患者CVA和痴呆发生率的研究有。每项研究的数据都通过随机效应模型进行组合。结果以95%置信区间（ci）的风险比报告。结果共纳入29项研究，379993例患者（平均年龄58±4岁，女性占30%）。平均随访36±23个月（12 ~ 120个月）。与内科治疗相比，房颤CA患者发生CVA的风险较低（优势比[OR] 0.54, 95% CI 0.42 - 0.69, I2 = 91%）。此外，与医疗管理相比，CA组痴呆的风险更低（OR 0.51, 95% CI 0.4-0.66, I2 = 74%）。CA组CVA发生率为1% (95% CI 1% ~ 2%, I2 = 97%)，痴呆发生率为2% （95% CI 2% ~ 8%, I2 = 97%）。结论在长期随访中，与单纯药物治疗相比，房颤ca治疗导致CVA和痴呆的风险较低。

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Catheter ablation for atrial fibrillation and risk of neurologic disease

Background

Catheter ablation (CA) of atrial fibrillation (AF) has been proven to benefit patients with symptomatic AF and heart failure. However, the data on neurological outcomes including cerebrovascular accidents (CVA) and dementia remain controversial.

Objective

We aimed to determine the effect of CA on neurological events during long-term follow-up.

Methods

We performed a systematic review and meta-analysis of patients with AF who underwent CA of AF. The MEDLINE, EMBASE, and Web of Science databases were comprehensively searched from inception to January 2024. Studies that reported incidence of CVA and dementia in patients with AF were. Data from each study were combined by a random-effects model. The results were reported in risk ratios with 95% confidence intervals (CIs).

Results

A total of 29 studies and 379,993 patients (mean age 58 ± 4 years, 30% women) were included in the analysis. Mean follow-up was 36 ± 23 months (range 12–120 months). Patients who underwent CA of AF had a lower risk of developing CVA compared with medical management (odds ratio [OR] 0.54, 95% CI 0.42–0 69, I² = 91%). Moreover, the risk of dementia was lower in the CA group compared with medical management (OR 0.51, 95% CI 0.4–0.66, I² = 74%). The incidence of CVA in the CA group was 1% (95% CI 1%–2%, I² = 97%), and the incidence of dementia was 2% (95% CI 2%–8%, I² = 97%).