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Tytuł:
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Atrioventricular node ablation and pacing for atrial tachyarrhythmias: A meta-analysis of postoperative outcomes.
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Autorzy:
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Baudo M; Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy. Electronic address: .
D'Ancona G; Department of Cardiovascular Research, Vivantes Klinikum Urban, Berlin, Germany.
Trinca F; Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Rosati F; Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Di Bacco L; Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Curnis A; Department of Cardiology, Spedali Civili di Brescia, Brescia, Italy.
Muneretto C; Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Metra M; Department of Cardiology, Spedali Civili di Brescia, Brescia, Italy.
Benussi S; Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
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Źródło:
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International journal of cardiology [Int J Cardiol] 2022 Sep 15; Vol. 363, pp. 80-86. Date of Electronic Publication: 2022 Jun 25.
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Typ publikacji:
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Journal Article; Meta-Analysis; Review
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Język:
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English
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Imprint Name(s):
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Publication: Amsterdam : Elsevier
Original Publication: Amsterdam : Elsevier/North-Holland Biomedical Press, c1981-
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MeSH Terms:
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Atrial Fibrillation*/diagnosis
Atrial Fibrillation*/surgery
Cardiac Resynchronization Therapy*/methods
Catheter Ablation*/adverse effects
Catheter Ablation*/methods
Heart Failure*
Atrioventricular Node/surgery ; Death ; Humans ; Tachycardia ; Treatment Outcome
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Contributed Indexing:
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Keywords: Ablate and pace; Atrial fibrillation; Atrioventricular node ablation; meta-analysis
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Entry Date(s):
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Date Created: 20220628 Date Completed: 20220719 Latest Revision: 20220924
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Update Code:
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20240105
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DOI:
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10.1016/j.ijcard.2022.06.058
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PMID:
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35764203
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Background: Atrioventricular node ablation (AVNA) and pacemaker (PM) is performed in symptomatic atrial fibrillation (AF) unresponsive to medical treatment and percutaneous ablation. This meta-analysis evaluated results after AVNA and PM.
Methods: Primary and secondary endpoints were early/late overall/cardiac-related mortality and early/late postoperative complications. Meta-regression explored mortality and preoperative characteristics relation.
Results: We selected 93 studies with 11,340 patients: 9105 right ventricular (RV)-PM, and 2235 biventricular PM (cardiac resynchronization therapy, CRT). Malignant arrhythmia (2.5%), heart failure (2.4%), and lead dislodgement (2.0%) were most common periprocedural complications. Pooled estimated 30-day mortality was 1.08% (95%CI:0.65-1.77). At 19.9 months median follow-up (IQR: 10.3-34 months), rehospitalization (0.79%/month) and heart failure (0.48%/month) were the most frequent complications. Overall mortality incidence rate (IR) was 0.43%/month (95%CI:0.36-0.51), and cardiac death IR 0.27%/month (95%CI:0.22-0.32). No mortality determinants emerged in the AVNA CRT subgroup. AVNA RV-PM subgroup univariable meta-regression showed inverse relationship between age, ejection fraction (EF), and late cardiac death (Beta = -0.0709 ± 0.0272; p = 0.0092 and Beta = -0.0833 ± 0.0249; p = 0.0008). Coronary artery disease (CAD) was directly associated to follow-up overall/cardiac mortality at univariable (Beta = 0.0550 ± 0.0136, p < 0.0001; Beta = 0.0540 ± 0.0130, p < 0.0001) and multivariable (Beta = 0.0460 ± 0.0189, p = 0.152; Beta = 0.0378 ± 0.0192, p = 0.0491) meta-regression.
Conclusions: Solid long-term evidence supporting AVNA and pace is lacking. Younger patients with reduced LVEF% have increased follow-up cardiac mortality after AVNA RV and may require CRT. Alternative strategies to maintain sinus rhythm and ventricular synchronism should be compared to AVNA to support future treatment strategies.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
