第二代冷冻球囊消融联合导管消融治疗持续性心房颤动的安全性和有效性：系统评价和荟萃分析。
The safety and efficacy of second-generation cryoballoon ablation plus catheter ablation for persistent atrial fibrillation: A systematic review and meta-analysis.
机构信息
Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
出版信息
PLoS One. 2018 Oct 25;13(10):e0206362. doi: 10.1371/journal.pone.0206362. eCollection 2018.
BACKGROUND
Growing evidence suggests that second-generation cryoballoon ablation (2G-CB) is effective in patients with persistent atrial fibrillation (PerAF). The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI). The purpose of this study was to summarize the available data on the safety and mid-term (≥ 12 months) effectiveness of a 'PVI-only' strategy vs. a 'PVI-plus' strategy using 2G-CB in patients with PerAF.
METHODS
We searched the PubMed, EMBASE and Cochrane library databases for studies on 2G-CB for PerAF. Group analysis was based on the ablation approach: 'PVI-only' versus 'PVI-plus', the latter of which involved PVI plus other substrate modifications. Studies showing clinical success rates at a follow-up (FU) of ≥ 12 months were included. Complication rates were also assessed. Data were analyzed by applying a fixed effects model.
RESULTS
A total of 879 patients from 5 studies were analyzed. After a mid-term FU of 27 months, the overall success rate of 2G-CB for PerAF was 66.1%. In the 'PVI-plus' group, the success rate was 73.8%. In the 'PVI-only' group, the success rate was 53.6%. No heterogeneity was noted among studies (I2 = 0.0%, P = 0.82). Complications occurred in 5.2% of patients (P = 0.93), and the rate of phrenic nerve (PN) injury was 2.8% (P = 0.14). Vascular assess complications were the most frequent at 1.6% (P = 0.33). No death or myocardial infarction was reported.
CONCLUSION
'PVI-plus' involving 2G-CB seems to be safe and effective for treating PerAF.
背景
越来越多的证据表明，第二代冷冻球囊消融（2G-CB）在持续性心房颤动（PerAF）患者中是有效的。心房颤动（AF）消融的基石是肺静脉隔离（PVI）。本研究旨在总结使用第二代冷冻球囊消融（2G-CB）治疗持续性心房颤动（PerAF）患者时，单纯 PVI 策略与 PVI 加其他基质改良策略的安全性和中期（≥12 个月）有效性的现有数据。
方法
我们在 PubMed、EMBASE 和 Cochrane 图书馆数据库中搜索了关于 2G-CB 治疗 PerAF 的研究。组分析基于消融方法：“单纯 PVI”与“PVI 加其他”，后者包括 PVI 加其他基质改良。纳入在随访（FU）≥12 个月时显示临床成功率的研究。还评估了并发症发生率。应用固定效应模型分析数据。
结果
共有 5 项研究的 879 例患者进行了分析。在 27 个月的中期 FU 后，2G-CB 治疗 PerAF 的总体成功率为 66.1%。在“PVI 加其他”组中，成功率为 73.8%。在“单纯 PVI”组中，成功率为 53.6%。研究之间没有异质性（I2=0.0%，P=0.82）。并发症发生率为 5.2%（P=0.93），膈神经（PN）损伤发生率为 2.8%（P=0.14）。血管评估并发症最常见，发生率为 1.6%（P=0.33）。无死亡或心肌梗死报告。
结论
涉及 2G-CB 的“PVI 加其他”似乎是治疗 PerAF 的安全有效的方法。
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