Chen Chao-Feng, Gao Xiao-Fei, Duan Xu, Chen Bin, Liu Xiao-Hua, Xu Yi-Zhou
Hangzhou First People's Hospital, Nanjing Medical University, Zhejiang Chinese Medical University, #261 Huansha Road, Shangcheng District, Hangzhou, Zhejiang, China.
Department of Cardiology, Hangzhou Hospital of Nanjing Medical University, #261 Huansha Road, Hangzhou, Zhejiang Province, China.
J Interv Card Electrophysiol. 2017 Apr;48(3):351-366. doi: 10.1007/s10840-016-0220-8. Epub 2017 Jan 7.
The present systematic review and meta-analysis aimed to assess and compare the safety and efficacy of radiofrequency (RF) and cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF). RF and CB ablation are two frequently used methods for pulmonary vein isolation in PAF, but which is a better choice for PAF remains uncertain.
A systematic review was conducted in Medline, PubMed, Embase, and Cochrane Library. All trials comparing RF and CB ablation were screened and included if the inclusion criteria were met.
A total of 38 eligible studies, 9 prospective randomized or randomized controlled trials (RCTs), and 29 non- RCTs were identified, adding up to 15,496 patients. Pool analyses indicated that CB ablation was more beneficial in terms of procedural time [standard mean difference = -0.58; 95% confidence interval (CI), -0.85 to -0.30], complications without phrenic nerve injury (PNI) [odds ratio (OR) = 0.79; 95% CI, 0.67-0.93; I = 16%], and recrudescence (OR = 0.83; 95% CI, 0.70-0.97; I = 63%) for PAF; however, the total complications of CB was higher than RF. The subgroup analysis found that, compared with non-contact force radiofrequency (non-CF-RF), both first-generation cryoballoon (CB1) and second-generation cryoballoon (CB2) ablation could reduce complications with PNI, procedural time, and recrudescence. However, the safety and efficacy of CB2 was similar to those of CF-RF.
Available overall and subgroup data suggested that both CB1 and CB2 were more beneficial than RF ablation, and the main advantages were reflected in comparing them with non-CF-RF. However, CF-RF and CB2 showed similar clinical benefits.
本系统评价和荟萃分析旨在评估和比较射频（RF）消融与冷冻球囊（CB）消融治疗阵发性心房颤动（PAF）的安全性和有效性。RF消融和CB消融是PAF肺静脉隔离的两种常用方法，但哪种方法对PAF是更好的选择仍不确定。
在Medline、PubMed、Embase和Cochrane图书馆进行了系统评价。筛选并纳入所有比较RF消融和CB消融的试验，前提是符合纳入标准。
共确定了38项符合条件的研究，其中9项前瞻性随机或随机对照试验（RCT）和29项非RCT，总计15496例患者。汇总分析表明，CB消融在手术时间方面更具优势[标准均差=-0.58；95%置信区间（CI），-0.85至-0.30]、无膈神经损伤（PNI）的并发症[比值比（OR）=0.79；95%CI，0.67-0.93；I²=16%]以及PAF的复发率（OR=0.83；95%CI，0.70-0.97；I²=63%）；然而，CB的总并发症高于RF。亚组分析发现，与非接触力射频（non-CF-RF）相比，第一代冷冻球囊（CB1）和第二代冷冻球囊（CB2）消融均可降低PNI并发症、手术时间和复发率。然而，CB2的安全性和有效性与CF-RF相似。
现有的总体和亚组数据表明，CB1和CB2均比RF消融更具优势，主要优势体现在与non-CF-RF的比较中。然而，CF-RF和CB2显示出相似的临床益处。
