Zhou X, Lv W, Zhang W, Ye Y, Li Y, Zhou Q, Zhang J, Xing Q, Lu Y, Zhang L, Wang H, Qin W, Tang B
Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Xinjiang Medical University, Urumqi, Xinjiang, China.
Braz J Med Biol Res. 2017 Aug 7;50(9):e6409. doi: 10.1590/1414-431X20176409.
This meta-analysis compared the efficacy and safety of the contact force (CF)-sensing catheter and second-generation cryoballoon (CB) ablation for treating atrial fibrillation (AF). Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD)=29.4; 95%CI=17.84-40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=-4.48-5.66; P=0.82). Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury) between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37-1.17; P=0.15). Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2%) of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03-0.43; P=0.001). A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR)=1.03; 95%CI=0.78-1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up), with shorter procedure duration and different complications in the CB group.
本荟萃分析比较了接触力（CF）感知导管和第二代冷冻球囊（CB）消融治疗心房颤动（AF）的疗效和安全性。通过检索PubMed、EMBASE、Cochrane图书馆、万方数据和中国知网，确定了6项比较使用CF感知导管或第二代CB进行AF消融的对照临床试验。CB组的手术时间明显低于CF组[平均差（MD）=29.4；95%置信区间（CI）=17.84 - 40.96；P = 0.01]，而两组间透视时间无差异（MD = 0.59；95%CI = - 4.48 - 5.66；P = 0.82）。此外，CB组和CF组之间非致命并发症（栓塞事件、心包填塞、股/锁骨下血肿、动静脉瘘、肺静脉狭窄、膈神经麻痹和食管损伤）的发生率无差异（8.38%对5.35%；风险比（RR）= 0.66；95%CI = 0.37 - 1.17；P = 0.15）。CB组326例患者中有17例（5.2%）发生短暂性膈神经麻痹，而CF组无1例发生（RR = 0.12；95%CI = 0.03 - 0.43；P = 0.001）。在单次消融术后12个月的随访中，CF组和CB组有相当比例的患者出现AF复发[风险比（RR）= 1.0；95%CI = 0.78 - 1.35；P = 0.84]。使用CF感知导管和第二代CB进行AF消融显示出相当的透视时间和疗效（在12个月的随访期间），CB组的手术时间更短，并发症不同。
