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首页> 外文期刊>Expert review of cardiovascular therapy >Remote magnetic navigation for catheter ablation of atrioventricular nodal reentrant tachycardia: A systematic review and meta-analysis
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Remote magnetic navigation for catheter ablation of atrioventricular nodal reentrant tachycardia: A systematic review and meta-analysis

机译：远程磁导航导管消融房室结折返性心动过速：系统评价和荟萃分析

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摘要

Catheter ablation has become a well-established, first-line therapy for atrioventricular nodal reentrant tachycardia (AVNRT), the most common reentry supraventricular tachycardia in humans. Robotic systems are becoming increasingly common in both complex and simple ablation procedures with presumed potential improvements in procedural efficacy and safety. The authors of this article conducted a systematic review and meta-analysis on the effectiveness and safety of the magnetic navigation system (MNS) in comparison with conventional catheter navigation for AVNRT ablation. An electronic search was performed using Cochrane Central database, Medline, Embase and Web of Knowledge between 2002 and 2012. References were searched manually. Outcomes of interest were: acute and long-term success, complications, total procedure, ablation and fluoroscopic times. Continuous variables were reported as standardized difference in means (SDM); odds ratios (OR) were reported for dichotomous variables. Thirteen studies (seven of which were nonrandomized controlled, four were case series and two were randomized controlled studies) involving 679 adult patients were identified. Twelve studies were based on a single center and one study was multicentral. MNS was deployed in 339 patients. The follow-up period ranged between 75 and 180 days. Acute success and long-term freedom from arrhythmia were not significantly different between MNS and control groups (98 vs 98%, OR: 0.94 [95% CI: 0.21-4.1] and 97 vs 96%, OR: 1.18 [95% CI: 0.35-4.0], respectively). A shorter fluoroscopic time was achieved with MNS; however, this did not reach statistical significance (15 vs 19 min, SDM: -0.26 [95% CI: -0.64-0.12]). Longer total procedure but similar ablation times were noted with MNS (160 vs 148 min, SDM: 3.48 [95% CI: 0.75-6.21] and 4 vs 6 min, SDM: -0.83 [95% CI: -2.19-0.53], respectively). The overall complication rate was similar between both groups (2.7 vs 1.0%, OR: 1.28 [95% CI: 0.33-4.96]). Our data suggest that the usage of MNS results in similar rates of success and complications when compared with conventional manual catheter ablation for AVNRT. MNS had a trend for reduced fluoroscopic time. Longer total procedure time was observed with MNS while the actual ablation time remained similar. Prospective randomized trials will be needed to better evaluate the relative role of MNS for catheter ablation of AVNRT.
机译：导管消融已成为房室结折返性心动过速（AVNRT）的一种行之有效的一线疗法，房室结折返性心动过速是人中最常见的。机器人系统在复杂和简单的消融手术中都变得越来越普遍，并且在程序功效和安全性方面也有望得到改善。与传统的用于AVNRT消融的导管导航相比，本文的作者对磁导航系统（MNS）的有效性和安全性进行了系统的回顾和荟萃分析。在2002年至2012年之间，使用Cochrane Central数据库，Medline，Embase和Web of Knowledge进行了电子搜索。手动搜索了参考文献。感兴趣的结果是：急性和长期成功，并发症，总过程，消融和透视时间。连续变量被报告为均值标准化差异（SDM）;报告了二分变量的比值比（OR）。确定了涉及679名成年患者的13项研究（其中7项为非随机对照研究，4例为病例系列研究，2例为随机对照研究）。十二项研究基于单个中心，一项研究是多中心的。 MNS被部署在339位患者中。随访期为75至180天。 MNS和对照组之间的急性成功和长期免于心律失常没有显着差异（98比98％，或：0.94 [95％CI：0.21-4.1]和97比96％，或：1.18 [95％CI： 0.35-4.0]）。 MNS可以缩短透视时间。但是，这没有达到统计学显着性（15分对19分钟，SDM：-0.26 [95％CI：-0.64-0.12]）。 MNS的总手术时间更长，但消融时间相似（160比148分钟，SDM：3.48 [95％CI：0.75-6.21]和4比6分钟，SDM：-0.83 [95％CI：-2.19-0.53]，分别）。两组的总并发症发生率相似（2.7 vs 1.0％，或：1.28 [95％CI：0.33-4.96]）。我们的数据表明，与传统的手动导管消融用于AVNRT相比，MNS的使用成功率和并发症发生率相似。 MNS有减少透视时间的趋势。 MNS观察到更长的总手术时间，而实际消融时间仍然相似。需要进行前瞻性随机试验，以更好地评估MNS对AVNRT导管消融的相对作用。

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