高功率短时程射频消融与冷冻球囊消融治疗心房颤动差异的荟萃分析
Difference between high-power short-duration radiofrequency ablation and cryoballoon ablation for in the treatment of atrial fibrillation:a meta-analysis and systematic review
张占欣 1鲁静朝 1靳雅琼 1王梦肖 1张洁 1王莉 1高存良1
作者信息
- 1. 河北医科大学第二医院心血管内二科,石家庄 050000
- 折叠
摘要
目的 评估高功率短时程射频消融(HPSD)与冷冻球囊消融(CBA)治疗心房颤动(房颤)的手术效率、有效性与安全性差异.方法 在PubMed、Embase、Cochrane Library、Web of Science等数据库中,计算机检索自建库至2023年12月发表的HPSD对比CBA治疗房颤的临床研究.经质量评价与数据提取后计算合并效应与安全性.结局指标包括房颤复发风险、手术效率、心功能、并发症发生情况等.采用RevMan 5.3统计软件进行荟萃分析评估HPSD对比CBA治疗房颤术后的房性心律失常复发率、手术时间及并发症等.结果 筛选后纳入6项原始研究,2 381例房颤患者,其中可提取数据的阵发性房颤患者共605例.荟萃分析结果显示,在首次消融的房颤患者中,相比于HPSD消融,CBA的手术时间[加权均方差(WMD)=29.35,95％CI 19.58～39.12,P＜0.001]、消融时间(WMD=12.89,95％CI 4.90～20.88,P=0.002)均明显缩短,X线曝光时间基本相似(WMD=-3.89,95％CI-12.16～4.38,P=0.360).HPSD组患者术后房性心律失常复发率略低于CBA组[17.38％(142/817)对24.29％(350/1 441),P=0.430],阵发性房颤患者中HPSD组复发率略高于CBA组[13.53％(41/303)对11.26％(34/302),P=0.400].此外,两组患者并发症风险基本相似[2.28％(20/879)对3.60％(54/1 502),P=0.110].结论 CBA较HPSD可显著提升手术效率,临床复发率和安全性基本相似.在房颤患者,尤其阵发性房颤患者中,CBA和HPSD消融是安全、有效、可行的消融策略.
Abstract
Objective To evaluate and compare the surgical efficiency,effectiveness and safety of high-power short-duration radiofrequency ablation(HPSD)and cryoballoon ablation(CBA)in the treatment of atrial fibrillation(AF)by Meta-analysis.Methods In PubMed,Embase,Cochrane Library and Web of Science the clinical studies comparing HPSD and CBA in the treatment of AF published from the establishment of the database to December 2023.After quality evaluation and data extraction,the combined effect and safety were calculated.The outcomes included the risk of AF recurrence,surgical efficiency,cardiac function,and complications.RevMan 5.3 statistical software was used for Meta-analysis.Results Six studies with 2 381 AF patients were included,of which 605 patients with paroxysmal AF had extractable data.The results of Meta-analysis showed that compared with HPSD ablation,procedure time[weighted mean difference(WMD)=29.35,95％CI 19.58-39.12,P＜0.001]and ablation time(WMD=12.89,95％CI 4.90-20.88,P=0.002)in CBA group were significantly shortened,but fluoroscopy time was similar(WMD=-3.89,95％CI-12.16-4.38,P=0.36).The recurrence rate of atrial arrhythmia in HPSD group was slightly lower than that in CBA group[17.38％(142/817)vs.24.29％(350/1441),P=0.430].In patients with paroxysmal AF,the recurrence rate of HPSD group was slightly higher than that of CBA group[13.53％(41/303)vs.11.26％(34/302),P=0.400].In addition,the incidence of complications was similar between the two groups[2.28％(20/879)vs.3.60％(54/1502),P=0.110].Conclusion CBA can significantly improve ablation efficiency compared with HPSD,and the clinical recurrence rate and safety are similar between CBA and HPSD.CBA and HPSD ablation strategies are safe,effective and feasible in AF patients,especially in paroxysmal AF patients.
关键词
心房颤动/高功率短时程/冷冻球囊/消融/荟萃分析Key words
Atrial fibrillation/High power short duration/Cryoballoon/Ablation/Meta-analysis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据