室性心动过速消融中的预防性机械循环支持：系统综述与荟萃分析。
完整摘要 · 中文译文
背景：预防性机械循环支持（MCS）用于室性心动过速（VT）消融的获益仍不清楚。本荟萃分析比较了预防性MCS与标准治疗用于VT消融的有效性和安全性。 方法：对PubMed、Embase和Web of Science进行无限制文献检索，确定关于预防性MCS用于VT消融的研究。MCS包括经皮左心室辅助装置或体外膜肺氧合。主要终点为全因死亡率；次要终点包括VT复发、手术时间、手术并发症（血管通路、出血、卒中、心包积液、心力衰竭、心肌梗死）和30天主要不良心血管事件（MACE）。 结果：共纳入8项研究，2262例患者（414例使用MCS，1848例未使用）。平均随访15.8个月，平均年龄62.6岁，12.5%为女性，MCS组平均PAINESD评分为15.7，非MCS组为10.5。全因死亡率（OR 1.58，95% CI 0.60-4.19，p = 0.36，I²=81%）或VT复发（OR 1.03，95% CI 0.68-1.56，p = 0.90，I²=46%）无显著差异。预防性MCS与更长的手术时间（平均差46.0分钟，95% CI 11.1-80.8，p = 0.01，I²=86%）、更多的手术并发症相关——主要由血管通路和心包积液驱动（OR 2.25，95% CI 1.26-4.03，p = 0.006，I²=33%）。30天MACE在各研究中的定义不一致，因此未进行合并。 结论：预防性MCS与全因死亡率的显著差异无关。 在接受室性心动过速（VT）消融的患者中，死亡率或室性心动过速（VT）复发，但与更长的操作时间和更多的操作并发症相关。证据的确定性非常低，这反映了观察性研究设计、组间基线不平衡和异质性；这些发现并不排除在高危患者中选择性使用机械循环支持（MCS），并需要在随机试验中得到证实。
完整摘要 · 英文原文
BACKGROUND: The benefit of preemptive mechanical circulatory support (MCS) for ventricular tachycardia (VT) ablation remains unclear. This meta-analysis compared the efficacy and safety of preemptive MCS to standard care for VT ablation. METHODS: An unrestricted literature search of PubMed, Embase, and Web of Science identified studies on preemptive MCS for VT ablation. MCS included percutaneous left ventricular assist devices or extracorporeal membrane oxygenation. The primary endpoint was all-cause mortality; secondary endpoints included VT recurrence, procedural time, procedural complications (vascular access, bleeding, stroke, pericardial effusion, heart failure, myocardial infarction), and 30-day major adverse cardiovascular events (MACE). RESULTS: Eight studies with 2,262 patients (414 with MCS, 1,848 without) were included. Mean follow-up was 15.8 months, mean age was 62.6 years, 12.5% were women, and mean PAINESD scores were 15.7 in the MCS group and 10.5 in the no-MCS group. There was no significant difference in all-cause mortality (OR 1.58, 95% CI 0.60-4.19, p = 0.36, I²=81%) or VT recurrence (OR 1.03, 95% CI 0.68-1.56, p = 0.90, I²=46%). Preemptive MCS was associated with longer procedural times (mean difference 46.0 min, 95% CI 11.1-80.8, p = 0.01, I²=86%), more procedural complications-driven by vascular access and pericardial effusion (OR 2.25, 95% CI 1.26-4.03, p = 0.006, I²=33%). Thirty-day MACE was not uniformly defined across studies and was therefore not pooled. CONCLUSIONS: Preemptive MCS was not associated with a significant difference in all-cause mortality or VT recurrence in patients undergoing VT ablation but was associated with longer procedures, and more procedural complications. The certainty of evidence was very low, reflecting the observational study design, baseline imbalance between groups, and heterogeneity; these findings do not preclude the selective use of MCS in high-risk patients and require confirmation in randomized trials.