Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.
ObjectivesTo systematically evaluate the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, WanFang Data, CNKI and VIP databases were electronically searched to collect cohort studies on the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation from inception to July 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 and Stata 12.0 software. ResultsA total of 12 cohort studies involving 4 051 patients were included. The results of meta-analysis showed that: there were no differences in the rate of thromboembolic (OR=0.92, 95%CI 0.36 to 2.35, P=0.86), ischemic stroke (OR=1.15, 95%CI 0.22 to 6.07, P=0.87), major bleeding (OR=0.84, 95%CI 0.43 to 1.66, P=0.61), minor bleeding (OR=0.90, 95%CI 0.60 to 1.34, P=0.60) and pericardial tamponade (OR=1.05, 95%CI 0.45 to 2.47, P=0.90) between dabigatran and rivaroxaban groups. ConclusionsCurrent evidence shows that the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.