RESUMO
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Estenose de Veia Pulmonar , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Ablação por Cateter/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hemorragia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Estenose de Veia Pulmonar/etiologia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Metanálise como AssuntoRESUMO
A gentleman in his early 50's with past medical history significant for biopsy confirmed pulmonary sarcoidosis presented with acute onset confusion, gait disturbance and bowel/urinary incontinence. Brain imaging was consistent with normal pressure hydrocephalus and CSF studies supported the suspicion of neurosarcoidosis. He received treatment with a prolonged course of steroids with good effect. We discuss a rare case of normal pressure hydrocephalus as a presenting feature of neurosarcoidosis and the rationale of starting empiric treatment for probable diagnosis of the same.