PDF(Pubmed)
Abstract：
UNASSIGNED: Pulsed-field ablation (PFA) is an alternative to thermal ablation (TA) in patients with atrial fibrillation (AF) receiving catheter-based therapy for pulmonary vein isolation (PVI). However, its efficacy and safety have yet to be fully elucidated.
UNASSIGNED: The purpose of this study was to compare the acute and long-term efficacies and safety of PFA and TA.
UNASSIGNED: We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials comparing PFA and TA in patients with AF undergoing their first PVI ablation. The TA group was divided into cryoballoon (CB) and radiofrequency subgroups. AF patients were divided into paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF) subgroups for further analysis.
UNASSIGNED: Eighteen studies involving 4998 patients (35.2% PFA) were included. Overall, PFA was associated with a shorter procedure time (mean difference [MD] -21.68; 95% confidence interval [CI] -32.81 to -10.54) but longer fluoroscopy time (MD 4.53; 95% CI 2.18-6.88) than TA. Regarding safety, lower (peri-)esophageal injury rates (odds ratio [OR] 0.17; 95% CI 0.06-0.46) and higher tamponade rates (OR 2.98; 95% CI 1.27-7.00) were observed after PFA. In efficacy assessment, PFA was associated with a better first-pass isolation rate (OR 6.82; 95% CI 1.37-34.01) and a lower treatment failure rate (OR 0.83; 95% CI 0.70-0.98). Subgroup analysis showed no differences in PersAF and PAF. CB was related to higher (peri)esophageal injury, and lower PVI acute success and procedural time.
UNASSIGNED: Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates in procedural data.
UNASSIGNED: The purpose of this study was to compare the acute and long-term efficacies and safety of PFA and TA.
UNASSIGNED: We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials comparing PFA and TA in patients with AF undergoing their first PVI ablation. The TA group was divided into cryoballoon (CB) and radiofrequency subgroups. AF patients were divided into paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF) subgroups for further analysis.
UNASSIGNED: Eighteen studies involving 4998 patients (35.2% PFA) were included. Overall, PFA was associated with a shorter procedure time (mean difference [MD] -21.68; 95% confidence interval [CI] -32.81 to -10.54) but longer fluoroscopy time (MD 4.53; 95% CI 2.18-6.88) than TA. Regarding safety, lower (peri-)esophageal injury rates (odds ratio [OR] 0.17; 95% CI 0.06-0.46) and higher tamponade rates (OR 2.98; 95% CI 1.27-7.00) were observed after PFA. In efficacy assessment, PFA was associated with a better first-pass isolation rate (OR 6.82; 95% CI 1.37-34.01) and a lower treatment failure rate (OR 0.83; 95% CI 0.70-0.98). Subgroup analysis showed no differences in PersAF and PAF. CB was related to higher (peri)esophageal injury, and lower PVI acute success and procedural time.
UNASSIGNED: Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates in procedural data.
摘要：
■在接受基于导管的肺静脉隔离（PVI）治疗的房颤（AF）患者中，脉冲场消融（PFA）是热消融（TA）的替代方法。然而,其有效性和安全性尚未完全阐明。
■本研究的目的是比较PFA和TA的急性和长期疗效和安全性。
■我们对进行首次PVI消融术的房颤患者的PFA和TA的随机和非随机对照试验进行了系统评价和荟萃分析。TA组分为冷冻球囊（CB）和射频亚组。将房颤患者分为阵发性房颤（PAF）和持续性房颤（PersAF）亚组进行进一步分析。
■纳入了18项研究，涉及4998名患者（35.2％PFA）。总的来说,与TA相比，PFA与较短的手术时间（平均差[MD]-21.68；95％置信区间[CI]-32.81至-10.54）相关，但透视时间更长（MD4.53；95％CI2.18-6.88）。关于安全,PFA后观察到较低的(围)食管损伤率(比值比[OR]0.17;95%CI0.06-0.46)和较高的填塞率(OR2.98;95%CI1.27-7.00).在疗效评估中，PFA与较好的首过隔离率(OR6.82;95%CI1.37-34.01)和较低的治疗失败率(OR0.83;95%CI0.70-0.98)相关。亚组分析显示PersAF和PAF没有差异。CB与较高（周围）食管损伤有关，减少PVI急性成功率和手术时间。
■与TA相比，PFA在急性和长期疗效方面显示出更好的结果，但在安全性方面存在显着差异。手术数据中（食管周围）损伤率较低，但填塞率较高。
■本研究的目的是比较PFA和TA的急性和长期疗效和安全性。
■我们对进行首次PVI消融术的房颤患者的PFA和TA的随机和非随机对照试验进行了系统评价和荟萃分析。TA组分为冷冻球囊（CB）和射频亚组。将房颤患者分为阵发性房颤（PAF）和持续性房颤（PersAF）亚组进行进一步分析。
■纳入了18项研究，涉及4998名患者（35.2％PFA）。总的来说,与TA相比，PFA与较短的手术时间（平均差[MD]-21.68；95％置信区间[CI]-32.81至-10.54）相关，但透视时间更长（MD4.53；95％CI2.18-6.88）。关于安全,PFA后观察到较低的(围)食管损伤率(比值比[OR]0.17;95%CI0.06-0.46)和较高的填塞率(OR2.98;95%CI1.27-7.00).在疗效评估中，PFA与较好的首过隔离率(OR6.82;95%CI1.37-34.01)和较低的治疗失败率(OR0.83;95%CI0.70-0.98)相关。亚组分析显示PersAF和PAF没有差异。CB与较高（周围）食管损伤有关，减少PVI急性成功率和手术时间。
■与TA相比，PFA在急性和长期疗效方面显示出更好的结果，但在安全性方面存在显着差异。手术数据中（食管周围）损伤率较低，但填塞率较高。
