Liu Xiao-Hua, Chen Chao-Feng, Gao Xiao-Fei, Xu Yi-Zhou
Hangzhou Hospital of Zhejiang Chinese Medical University, Shangcheng District, Hangzhou City, Zhejiang Province, China.
Department of Cardiology, Hangzhou Hospital of Nanjing Medical University, Shangcheng District, Hangzhou City, Zhejiang Province, China.
Pacing Clin Electrophysiol. 2016 Aug;39(8):883-99. doi: 10.1111/pace.12889. Epub 2016 Jun 13.
Previous studies suggested that cryoballoon ablation had clinical benefits comparable to those of radiofrequency ablation. However, recently, some new catheters have been invented, and no universal consensus exists on which ablation is the optimal choice. The present systematic review and meta-analysis aimed to assess and compare the safety and efficacy of cryoballoon and radiofrequency ablation by synthesizing published trials.
A systematic literature review was conducted searching Medline, PubMed, Embase, Cochrane Library, and so forth. All trials comparing cryoballoon and radiofrequency ablation were screened and included if inclusion criteria were met. A total of 40 eligible studies were identified, adding up to 11,395 patients. The follow-up period ranged from 3 months to 25 months. Overall analyses indicated that cryoballoon ablation could bring more benefit in procedural time (risk ratio [RR] = -0.39, 95% confidence interval [CI]: -0.62 to -0.15), atrial fibrillation (AF) recrudescence (RR = 0.82, 95% CI: 0.70-0.96), and major complications (RR = 0.74, 95% CI: 0.58-0.95) for patients with AF. For the subgroups, the first-generation cryoballoon significantly reduced procedural time and major complications, but it increased ablation time. The patients referred for the second-generation cryoballoon (CBA) seemed to receive more clinical benefit (procedural time, fluoroscopic time, ablation time, AF recrudescence) and fewer complications. Finally, multiparty catheter (MTCA) was found to significantly reduce procedural and fluoroscopic times with a high rate of AF recrudescence.
The present systematic review and meta-analysis demonstrated that cryoballoon ablation was associated with greater freedom from AF, shorter procedural time, and lower rate of major complications, compared with radiofrequency ablation. Especially, CBA was more advantageous. However, MTCA seems promising for radiofrequency ablation.
先前的研究表明，冷冻球囊消融术具有与射频消融术相当的临床益处。然而，最近发明了一些新型导管，对于哪种消融术是最佳选择尚无普遍共识。本系统评价和荟萃分析旨在通过综合已发表的试验来评估和比较冷冻球囊消融术和射频消融术的安全性和有效性。
进行了一项系统的文献综述，检索了Medline、PubMed、Embase、Cochrane图书馆等。所有比较冷冻球囊消融术和射频消融术的试验均经过筛选，若符合纳入标准则纳入。共确定了40项符合条件的研究，总计11395例患者。随访期为3个月至25个月。总体分析表明，对于房颤患者，冷冻球囊消融术在手术时间（风险比[RR]= -0.39，95%置信区间[CI]：-0.62至-0.15）、房颤复发（RR = 0.82，95% CI：0.70 - 0.96）和主要并发症（RR = 0.74，95% CI：0.58 - 0.95）方面能带来更多益处。对于亚组分析，第一代冷冻球囊显著缩短了手术时间和主要并发症，但增加了消融时间。接受第二代冷冻球囊（CBA）治疗的患者似乎获得了更多临床益处（手术时间、透视时间、消融时间、房颤复发）且并发症更少。最后，发现多极导管（MTCA）能显著缩短手术和透视时间，但房颤复发率较高。
本系统评价和荟萃分析表明，与射频消融术相比，冷冻球囊消融术与更低的房颤复发率、更短的手术时间和更低的主要并发症发生率相关。特别是，CBA更具优势。然而，MTCA对于射频消融术似乎很有前景。
