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Heart：肥厚型心肌病心房颤动进行导管消融有效吗？

2016-09-24 MedSci MedSci原创

肥厚型心肌病心房颤动
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荟萃分析结果表明肥厚型心肌病患者进行房颤导管消融治疗的并发症发生率较低。尽管复发的风险是非HCM患者的2倍，导管消融在HCM合并AF患者治疗上是有效的和安全的，特别是心房较小的、阵发性房颤患者效果更加明显。

在肥厚性心肌病（HCM）的患者中发生心房颤动（房颤）很是常见，而且房颤是卒中的高危因素。导管消融在这种肥厚性心肌病合并房颤的患者中，其有效性和安全性值得进一步研究。近日，心脏病领域权威杂志《Heart》上发表了英国伦敦巴特的心脏中心Providencia医生及其团队的文章，旨在系统地回顾现有的文献并进行荟萃分析，以确定与HCM患者房颤导管消融的疗效。

研究者对MEDLINE、EMBASE、Cochrane以及clinicaltrials.gov进行了搜索。十四项研究被认为有资格进行系统评价，其中五项被纳入荟萃分析。采用荟萃分析研究的随机效应比较了HCM组与非HCM。评估了无房颤/房性心动过速和急性操作相关的并发症的预后。无HCM患者不复发房颤/房速比例较高（进行单次操作：38.7% HCM vs 49.8%对照，比值比为2.25，95% 可信区间1.09～4.64，P=0.03；进行两次及以上操作：51.8% HCM vs 71.2%对照，比值比为2.62，95%可信区间1.52～4.51，P=0.0006；I2分别为33%和26%，）。操作相关的不良事件的风险是低的。为防止心律失常复发，重复操作（平均差异为0.16，95% 可信区间0～0.32，P=0.05，I2为53%）和抗心律失常药物（比值比为4.70，95%可信区间2.31～9.55，P＜0.0001，I2为0%）在HCM患者更为频繁的使用。敏感性分析表明，心房扩张较小和阵发性房颤的HCM患者可能更类似于普通人群患者的预后。

荟萃分析结果表明肥厚型心肌病患者进行房颤导管消融治疗的并发症发生率较低。尽管复发的风险是非HCM患者的2倍，导管消融在HCM合并AF患者治疗上是有效的和安全的，特别是心房较小的、阵发性房颤患者效果更加明显。 

原始出处： Rui Providencia, et al. Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis. Heart. 2016. doi:10.1136/heartjnl-2016-309406

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    2016-09-26 zhaojie88

    #ART#

    0

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    2016-09-26 wjcjjian

    #导管消融#

    0

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    2016-09-26 xiangyuzhou972

    #消融#

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    2016-09-26 slcumt

    #HEART#

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    2016-09-26 爆笑小医

    #肌病#

    0

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    2016-09-26 sodoo

    #心房#

    0

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