射频消融术对房颤患者左心房容积及功能影响的Meta分析

摘要

Objective: To systematically review the effect of radiofrequency catheter ablation ( RFCA ) on left atrial (LA) size, volumes and function in patients with atrial fibrillation (AF).Methods: We searched MEDLINE, EMBASE, ScienceDirct , Highwire , Cochrane Central Register of Controlled Trials , Cochrane database of systematic reviews and the reference lists of retrieved reports in July 2012 .Studies conducted in patients with AF were included if the primary outcomes of the researches were changes of LA size or volumes and /or function after RFCA .Mean differences for changes of LA diameter (LAD),LA maximum volume(LAVmax),LA minimum volume(LAVmin), LA ejection fraction ( LAEF ) , LA active emptying fraction ( LAAEF ) and LA strain were estimated using fixed-effects and random-effects Meta-analyses.Results:Twenty six studies (enrolling 1 821 patients) were included in the final analysis .Compared to preablation values , there were significant decreases in LA diameter and LA volumes at postablation follow-up.However, compared to preablation values , there was no significant differences in LA ejection fraction/LA active emptying fraction and LA strain at postablation follow-up.Decreases in LA diameter and LA volumes remained significant in those without AF recurrence but not in those with AF recurrence .LA ejection fraction/LA active emptying fraction did not decrease in patients without AF recurrence , whereas they decreased in patients with AF recurrence .As for LA strain, it seemed that LA strain increased in patients without AF recurrence , with less fibrosis and with more LA volumes decrease , but the differences was not significant . Conclusion:Successful RFCA in patients with AF significantly decreases LA size and volumes , and does not seem to adversely affect LA function .%目的：通过文献回顾来评价射频消融术对房颤患者左心房大小、容积及功能的影响。方法：计算机检索MEDLINE、EMBASE、ScienceDirct、Highwire、Cochrane 图书馆临床随机对照试验资料库（2000年1月至2012年12月）中评价射频消融术对左心房大小、容积或功能影响的随机对照研究，按照标准筛查文献，提取资料，采用Review Manager 4．2．9对数据进行Meta分析。结果：共纳入26项研究，均为英文，共1821例患者。结果表明，射频消融术后左心房直径及容积较术前降低，但是左心房射血分数/左心房主动排空指数较术前未见明显降低。在亚组分析时我们发现左心房直径及容积的降低在房颤未复发组较复发组明显，而左心房射血分数/左心房主动排空指数在未复发组及复发组均未见明显降低。结论：成功的射频消融术可以降低房颤患者左心房的直径和容积，且不影响左心房功能。