背景:持续性心房颤动(PeAF)对于节律控制模式是一个具有挑战性的病例。导管消融术是PeAF管理的主要手段;然而,关于冷冻球囊消融(CBA)与射频消融(RFA)治疗PeAF的安全性和疗效比较的数据仍然有限.我们旨在比较CBA和RFA用于PeAF消融的安全性和有效性。
方法:我们进行了系统评价和荟萃分析,综合了随机对照试验(RCTs),通过系统地搜索PubMed来检索,EMBASE,WebofScience,Scopus,和科克伦到2023年10月。RevMan5.4版软件用于使用风险比(RR)的二分数据和使用平均差(MD)的连续数据以及95%置信区间(CI)。
■CRD42023480314。
结果:纳入了三个RCT,共400名患者。RFA和CBA在房颤复发方面无显著差异(RR:0.77,95%CI[0.50,1.20],P=0.25),房性心动过速或房扑复发(RR:0.54,95%CI[0.11,2.76],P=0.46),和任何心律失常复发(RR:0.96,95%CI[0.70,1.31],P=0.80)。CBA与总手术持续时间减少显著相关(MD:-45.34,95%CI[-62.68,-28.00],P<0.00001),透视持续时间无显著差异(MD:3.59,95%CI[-5.13,12.31],P=0.42)。两组的安全参数相似,包括任何并发症的发生率,膈神经麻痹(RR:2.91,95%CI[0.31,27.54],P=0.35),进入部位并发症(RR:0.33,95%CI[0.05,2.03],P=0.23),和心包积液.
结论:在PeAF导管消融中,CBA在安全性和有效性方面与RFA相当。此外,CBA与较短的总手术持续时间相关联。
BACKGROUND: Persistent Atrial Fibrillation (PeAF) is a challenging case for rhythm control modalities. Catheter ablation is the mainstay in PeAF management; however, data regarding the comparative safety and efficacy of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for PeAF is still limited. We aim to compare the safety and efficacy of CBA versus RFA for PeAF ablation.
METHODS: We conducted a systematic
review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through October 2023. RevMan version 5.4 software was used to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI).
UNASSIGNED: CRD42023480314.
RESULTS: Three RCTs with 400 patients were included. There was no significant difference between RFA and CBA regarding AF recurrence (RR: 0.77, 95% CI [0.50, 1.20], P = 0.25), atrial tachycardia or atrial flutter recurrence (RR: 0.54, 95% CI [0.11, 2.76], P = 0.46), and any arrhythmia recurrence (RR: 0.96, 95% CI [0.70, 1.31], P = 0.80). CBA was significantly associated with decreased total procedure duration (MD: - 45.34, 95% CI [- 62.68, - 28.00], P < 0.00001), with no significant difference in fluoroscopy duration (MD: 3.59, 95% CI [- 5.13, 12.31], P = 0.42). Safety parameters were similar in both groups, including the incidence of any complications, phrenic nerve palsy (RR: 2.91 with 95% CI [0.31, 27.54], P = 0.35), access site complications (RR: 0.33 with 95% CI [0.05, 2.03], P = 0.23), and pericardial effusion.
CONCLUSIONS: In PeAF catheter ablation, CBA is comparable to RFA in terms of safety and efficacy. Also, CBA is associated with a shorter total procedure duration.