Difference in benefits between rhythm therapy and heart rate therapy for atrial fibrillation:a Meta-analysis
王兆博 1李盈盈 2林谦1
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作者信息
1. 100700 北京,北京中医药大学东直门医院
2. 100700 北京,中国中医科学院医学实验中心
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摘要
目的 心房颤动(房颤)的节律和心率治疗是两种常见的治疗策略,目前两者之间的选择仍存在争议,本研究通过荟萃分析评估这两种策略的综合获益.方法 在Cochrane Central Register of Controlled Trials、Embase、PMC和Web of Science中搜索随机对照试验.使用STATA 15.0软件来评估研究的效果、敏感性、异质性和发表偏倚.结果 研究共纳入了22项试验,42037例参与者.与速率控制组相比,节律治疗获得的主要终点事件更少,且随时间增加更加更为显著.5年随访显示,两组的远期生存率无明显差异.节律控制对左心室射血分数(LVEF,SMD=-0.40,95%CI:-0.68～-0.13,P=0.004)、代谢当量(METs,SMD=-0.42,95%CI:-0.76～-0.08,P=0.016)、运动耐受时间(SMD=-0.71,95%CI:-0.76～-0.49,P=0.000)和生活质量(QOL)评分(SMD=-0.92,95%CI:-1.76,-0.07,P=0.034)的改善更加显著.在节律控制组中缺血性卒中更少(OR=0.85,95%CI:0.78,0.94,P=0.016).在左心房内径(LAD)、左心室舒张末期内径(LVEDD)、栓塞事件中两种治疗策略无显著性差异.结论 恢复窦性心律可显著改善心功能和生活质量,节律控制的综合获益在长期治疗中更为显著.心率控制一直被认为是一种可行的妥协方案,但节律性治疗无疑将是更广阔的发展前景.与之前的指南相比,这项荟萃分析建议采用更积极的节律性治疗.
Abstract
Objective To review the combined benefits of rhythm therapy and heart rate(HR)therapy for atrial fibrillation(AF)through a Meta-analysis.Methods The databases of Cochrane Central Register of Controlled Trials,Embase,PMC and Web of Science were retrieved for screening randomized controlled trials(RCT),and effects,sensitivity,heterogeneity and publication bias were reviewed by using STATA 15.0 software.Results A total of 22 RCT with 42,037 participants were included in the study.The primary endpoint events were less in rhythm therapy group compared with HR therapy group,which was more significantly with increasing time.The results of 5-y follow-up showed that long-term survival rate had no significant difference between 2 groups.The improvement of left ventricular ejection fractions(LVEF,SMD=-0.40,95%CI:-0.68～-0.13,P=0.004),metabolic equivalents(METs,SMD=-0.42,95%CI:-0.76～-0.08,P=0.016),exercise tolerance time(SMD=-0.71,95%CI:-0.76～-0.49,P=0.000)and scores of quality of life(QOL,SMD=-0.92,95%CI:-1.76,-0.07,P=0.034)were more significant,and ischemic stroke(OR=0.85,95%CI:0.78,0.94,P=0.016)was less in rhythm therapy group.The differences in left atrial diameter(LAD),left ventricular end-diastolic dimension(LVEDD)and embolism events were not significant between 2 groups.Conclusion Restoration of sinus rhythm can significantly improve heart function and QOL,and the combined benefit of rhythm control is more significant in long-term treatment.Heart rate control has long been considered a viable compromise option,but rhythm therapy will undoubtedly be the broader development.This Meta-analysis recommends more aggressive rhythm therapy compared to previous guidelines.
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