Data_Sheet_1_Efficacy of left atrial low-voltage area-guided catheter ablation of atrial fibrillation: An updated systematic review and meta-analysis.zip

AimsThis study aimed to evaluate the efficacy of low-voltage area (LVA)-guided substrate modification catheter ablation in patients with atrial fibrillation (AF).
MethodsSystematic searches of the PubMed, EMBASE, and Cochrane databases were performed from inception to July 2022 for all available studies. The effect estimates were combined with the Mantel–Haenszel random-effects model. Subgroup analyses, sensitivity analysis, and meta-regression were conducted to explore the sources of statistical heterogeneity.
ResultsA total of 16 studies involving 1942 subjects (mean age: 61 ± 10 years, 69% male) were identified. All studies included patients with paroxysmal AF, non-paroxysmal AF, or both. At a mean follow-up of 18.9 months, patients who underwent LVA-guided substrate modification ablation had significantly higher freedom from all-atrial tachycardia recurrence than patients who underwent control ablation [67.7% vs. 48.9%, risk ratios (RR) 0.64, 95% confidence interval (CI) 0.55–0.76, P < 0.001], with 36% relative risk and 18.7% absolute risk reductions in all-atrial tachycardia recurrence. Subgroup analysis based on AF types demonstrated that the decreased risk of all-atrial tachycardia recurrence was present predominantly in non-paroxysmal AF compared with paroxysmal AF (RR 0.60, 95% CI 0.52–0.69 vs. RR 0.96, 95% CI 0.81–1.13).
ConclusionLow-voltage area-guided substrate modification ablation combined with PVI appears to have a significant beneficial effect of improving freedom from all-atrial tachycardia recurrence, especially in patients with non-paroxysmal AF.

本研究旨在评估低压区（Low-voltage area, LVA）指导下基质改良导管消融治疗心房颤动（Atrial fibrillation, AF）患者的临床疗效。
方法 系统检索PubMed、EMBASE及Cochrane数据库自建库至2022年7月的所有相关研究。采用曼特尔-亨塞尔（Mantel–Haenszel）随机效应模型合并效应量，通过亚组分析、敏感性分析及Meta回归探究统计学异质性来源。
结果 共纳入16项研究，涉及1942名受试者（平均年龄61±10岁，男性占比69%）。所有研究均纳入阵发性心房颤动、非阵发性心房颤动或二者兼具的患者。在平均18.9个月的随访期内，接受低压区指导下基质改良消融的患者，其无全房性心动过速复发率显著高于对照组消融患者[67.7% vs. 48.9%，风险比（Risk ratios, RR）0.64，95%置信区间（Confidence interval, CI）0.55~0.76，P<0.001]，全房性心动过速复发的相对风险降低36%，绝对风险降低18.7%。基于心房颤动类型的亚组分析显示，与阵发性心房颤动患者相比，非阵发性心房颤动患者的全房性心动过速复发风险降低更为显著（风险比0.60，95%置信区间0.52~0.69 vs. 风险比0.96，95%置信区间0.81~1.13）。
结论 低压区指导下的基质改良消融联合肺静脉隔离（Pulmonary vein isolation, PVI），可显著提升无全房性心动过速复发率，尤其适用于非阵发性心房颤动患者。