■冷冻消融术已成为公认的治疗心房颤动(AF)的介入策略。许多试验已经研究了冷冻消融作为AF的一线疗法。这项荟萃分析旨在评估冷冻消融术对有症状房颤患者的生活质量(QoL)和安全性结果的影响,与抗心律失常药物(AAD)相比。
■对PubMed的全面搜索,EMBASE,和CochraneLibrary数据库进行随机对照试验(RCT),比较冷冻消融术和AAD作为AF的一线治疗,直至2023年5月.连续结果数据采用均差(MD)和95%置信区间(CI)进行分析。和二分结局数据使用95%CI的相对风险(RR)进行分析。评估的主要结果是QoL和严重不良事件。
■我们的分析包括四个RCT,涉及928名患者。与AAD治疗相比,冷冻消融与房颤对生活质量(AFEQT)评分(3项试验;MD7.46,95%CI2.50至12.42;p=0.003;I2=79%)和EQ-VAS评分(2项试验;MD1.49,95%CI1.13至1.86;p<0.001;I2=0%)的显着改善相关。此外,与AAD治疗相比,冷冻消融显示EQ-5D评分较基线略有增加,无统计学意义(2项试验;MD0.03,95%CI-0.01至0.07;p=0.07;I2=79%)。此外,与AAD治疗相比,冷冻消融治疗严重不良事件的发生率显着降低(4项试验;11.8%vs.16.3%;RR,0.73;95%CI,0.54-1.00;p=0.05;I2=0%)。冷冻消融还与总体不良事件的减少有关。持续性房颤的发生率,住院治疗,和额外的消融。然而,两个治疗组的主要不良心血管事件和急诊就诊次数无显著差异.
■冷冻消融,作为有症状的房颤患者的一线治疗,显著改善房颤患者的生活质量,减少严重不良事件,以及整体不良事件,持续性房颤,住院治疗,以及与AAD相比的额外消融。
UNASSIGNED: Cryoablation has emerged as a recognized interventional strategy for the treatment of atrial fibrillation (AF). Numerous trials have investigated
cryoablation as a first-line therapy for AF. This meta-analysis aimed to evaluate the impact of
cryoablation on quality of life (QoL) and safety outcomes compared to antiarrhythmic drugs (AADs) in patients with symptomatic AF.
UNASSIGNED: A comprehensive search of the PubMed, EMBASE, and Cochrane Library databases was conducted for randomized controlled trials (RCTs) comparing cryoablation and AADs as first-line treatments for AF until May 2023. Continuous outcome data were analyzed using mean differences (MDs) with 95% confidence intervals (CIs), and dichotomous outcome data were analyzed using relative risks (RRs) with 95% CIs. The primary outcomes assessed were QoL and serious adverse events.
UNASSIGNED: Our analysis included four RCTs involving 928 patients.
Cryoablation was associated with a significant improvement in the AF Effect on Quality of Life (AFEQT) score (3 trials; MD 7.46, 95% CI 2.50 to 12.42; p = 0.003; I 2 = 79%) and EQ-VAS score (2 trials; MD 1.49, 95% CI 1.13 to 1.86; p < 0.001; I 2 = 0%) compared to AAD therapy. Additionally, cryoablation demonstrated a modest increase in EQ-5D score from baseline compared to AAD therapy, with no statistically significance (2 trials; MD 0.03, 95% CI -0.01 to 0.07; p = 0.07; I 2 = 79%). Furthermore, the rate of serious adverse events was significantly lower with
cryoablation compared to AAD therapy (4 trials; 11.8% vs. 16.3%; RR, 0.73; 95% CI, 0.54-1.00; p = 0.05; I 2 = 0%). Cryoablation was also associated with a reduction in overall adverse events, incidence of persistent AF, hospitalizations, and additional ablation. However, there was no significant difference in major adverse cardiovascular events and emergency department visits between the two treatment groups.
UNASSIGNED: Cryoablation, as a first-line treatment for symptomatic AF patients, significantly improved AF-specific quality of life and reduced serious adverse events, as well as overall adverse events, persistent AF, hospitalizations, and additional ablation compared to AADs.