Jiang Jingbo, Li Jinyi, Zhong Guoqiang, Jiang Junjun
Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi Autonomous Region, People's Republic of China.
Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, People's Republic of China.
J Interv Card Electrophysiol. 2017 Jan;48(1):69-79. doi: 10.1007/s10840-016-0191-9. Epub 2016 Sep 28.
Currently, radiofrequency (RF) and cryoballoon are the most commonly used ablation technologies for atrial fibrillation (AF). We performed a meta-analysis to assess the efficacy and safety of the second-generation cryoballoons (CB-2) compared with RF for paroxysmal atrial fibrillation (PAF) ablation.
The PubMed, Cochrane Library, and Embase databases were searched and qualified studies were identified. The primary clinical outcome was the recurrence rate of atrial tachyarrhythmia (AT), and the secondary clinical outcomes were procedure time, fluoroscopy time, and the complications that followed.
Nine observational studies (2336 patients) with a mean follow-up period ranging from 8.8 to 16.8 months were included. The CB-2 group was associated with a significantly lower recurrence rate of ATs (20.8 versus 29.8 %, p = 0.01). In subgroup analysis, compared with non-contact force sensing (NCF) catheter, using CB-2 showed significantly reduced incidence of ATs (22.0 versus 38.5 %, p < 0.00001). However, the difference became negligible in contrast with contact force sensing (CF) catheter. Moreover, the CB-2 group had a tendency to decrease procedure time (weighted mean difference -39.72 min, p = 0.0003), whereas fluoroscopy time was similar between the two groups. The total complication rate showed no statistical difference (8.8 versus 4.4 %, p = 0.08). Almost all the cases of phrenic nerve palsy occurred in the CB-2 group, whereas pericardial tamponade was seldom manifested in the CB-2 group.
CB-2 tended to be more effective in comparison to NCF catheter and at least non-inferior to CF catheter, with shorter procedure time and similar safety endpoint.
目前，射频（RF）和冷冻球囊是心房颤动（AF）最常用的消融技术。我们进行了一项荟萃分析，以评估第二代冷冻球囊（CB-2）与射频用于阵发性心房颤动（PAF）消融的疗效和安全性。
检索了PubMed、Cochrane图书馆和Embase数据库，并确定了符合条件的研究。主要临床结局是房性快速性心律失常（AT）的复发率，次要临床结局是手术时间、透视时间及随后的并发症。
纳入9项观察性研究（2336例患者），平均随访时间为8.8至16.8个月。CB-2组ATs的复发率显著较低（20.8%对29.8%，p = 0.01）。在亚组分析中，与非接触力感知（NCF）导管相比，使用CB-2显示ATs的发生率显著降低（22.0%对38.5%，p < 0.00001）。然而，与接触力感知（CF）导管相比，差异变得微不足道。此外，CB-2组有缩短手术时间的趋势（加权平均差-39.72分钟，p = 0.0003），而两组的透视时间相似。总并发症发生率无统计学差异（8.8%对4.4%，p = 0.08）。几乎所有膈神经麻痹病例都发生在CB-2组，而CB-2组很少出现心包填塞。
与NCF导管相比，CB-2往往更有效，且至少不劣于CF导管，手术时间更短，安全终点相似。
