Chen Yi-He, Lu Zhao-Yang, Xiang Yin-, Hou Jian-Wen, Wang Qian, Lin Hui, Li Yi-Gang
Department of Cardiology, Xinhua Hospital Affiliated to The Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China.
Department of Respiratory, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China.
Europace. 2017 May 1;19(5):784-794. doi: 10.1093/europace/euw330.
Cryoablation is a promising alternative technique to RF ablation for treating paroxysmal AF with encouraging results. However, data about the efficacy and safety comparison between cryoablation and RF ablation is still lacking.
We systematically search the PubMed, the Cochrane Library, MEDLINE and Google Scholar databases, and finally identify 16 eligible studies including 7195 patients (2863 for cryoablation; 4332 for RF ablation). Freedom from AF/atrial tachycardial replase is slightly higher in cryoablation than RF ablation during a median 12 months of follow-up, with no statistical significant (RR: 1.05, 95% CI: 0.98-1.13, P = 0.159). In cryoablation, the procedure time is substantially shortened (WMD: -27.66, 95% CI: -45.24 to - 10.08, P = 0.002), whereas the fluoroscopy time is identical to RF ablation (WMD: -0.37, 95% CI: -2.78 to 2.04, P = 0.763). Procedure-related adverse events in cryoablation are parallel with that in RF ablation (RR: 1.08, 95% CI: 0.86-1.35, P = 0.159).
Compared with RF ablation, cryoablation present a comparable long-term AF/atrial tachycardial-free survival and procedure-related adverse events. Meanwhile, cryoablation markedly shorten the procedure time, nonetheless, with negligible impact on the fluoroscopy time.
冷冻消融是一种有前景的替代技术，用于治疗阵发性房颤，效果令人鼓舞。然而，关于冷冻消融和射频消融疗效与安全性比较的数据仍然缺乏。
我们系统检索了PubMed、Cochrane图书馆、MEDLINE和谷歌学术数据库，最终确定了16项符合条件的研究，包括7195例患者（冷冻消融组2863例；射频消融组4332例）。在中位12个月的随访期间，冷冻消融组无房颤/房性心动过速复发的比例略高于射频消融组，但无统计学显著差异（风险比：1.05，95%置信区间：0.98 - 1.13，P = 0.159）。在冷冻消融中，手术时间显著缩短（加权均数差：-27.66，95%置信区间：-45.24至-10.08，P = 0.002），而透视时间与射频消融相同（加权均数差：-0.37，95%置信区间：-2.78至2.04，P = 0.763）。冷冻消融的手术相关不良事件与射频消融相似（风险比：1.08，95%置信区间：0.86 - 1.35，P = 0.159）。
与射频消融相比，冷冻消融在长期无房颤/房性心动过速生存率及手术相关不良事件方面相当。同时，冷冻消融显著缩短了手术时间，不过对透视时间的影响可忽略不计。
