Jia Kangni, Jin Qi, Liu Ao, Wu Liqun
Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Electrocardiol. 2019 Jul-Aug;55:78-86. doi: 10.1016/j.jelectrocard.2019.05.001. Epub 2019 May 8.
The aim of this review was to evaluate the efficacy and safety between remote magnetic navigation (RMN) and manual control navigation (MCN) for atrial fibrillation (AF) ablation.
We searched the PubMed, EMBASE and Cochrane library databases using the key words AF, ablation and magnetic navigation.
Eighteen studies were identified in this analysis including 4046 patients comparing RMN and MCN in AF ablation, which were all non-randomized controlled studies. No significant difference of AF recurrence rate (40% vs. 38%, OR 1.00, 95% CI 0.82-1.22, p = 0. 97) and acute success rate in achieving pulmonary vein isolation (91% vs. 93%, OR 0.44, 95% CI 0.16-1.17, p = 0.10) was found between RMN and MCN. However, compared with MCN, RMN was associated with significantly lower complication rate (2% vs. 5%, OR 0.44, 95% CI 0.28-0.69, p = 0. 0003) and shorter fluoroscopy time (MD -9.71 min, 95% CI -15.80 to -3.63, p = 0.002). Procedure time (MD 47.05 min, 95% CI 27.5-66.58, p < 0.00001) and ablation time (MD 15.90 min, 95% CI 9.62-22.18, p < 0.00001) of RMN guided AF ablation were significantly longer than those of MCN.
The results of this study suggest that RMN is as effective as MCN in achieving pulmonary vein isolation and freedom from AF recurrence, and has superior safety with less complications and shorter fluoroscopy time.
本综述的目的是评估远程磁导航（RMN）与手动控制导航（MCN）在心房颤动（AF）消融中的疗效和安全性。
我们使用关键词AF、消融和磁导航检索了PubMed、EMBASE和Cochrane图书馆数据库。
本分析共纳入18项研究，包括4046例在AF消融中比较RMN和MCN的患者，均为非随机对照研究。RMN和MCN之间在AF复发率（40%对38%，OR 1.00，95%CI 0.82-1.22，p = 0.97）和实现肺静脉隔离的急性成功率（91%对93%，OR 0.44，95%CI 0.16-1.17，p = 0.10）方面未发现显著差异。然而，与MCN相比，RMN的并发症发生率显著更低（2%对5%，OR 0.44，95%CI 0.28-0.69，p = 0.0003），透视时间更短（MD -9.71分钟，95%CI -15.80至-3.63，p = 0.002）。RMN引导的AF消融的手术时间（MD 47.05分钟，95%CI 27.5-66.58，p < 0.00001）和消融时间（MD 15.90分钟，95%CI 9.62-22.18，p < 0.00001）显著长于MCN。
本研究结果表明，RMN在实现肺静脉隔离和预防AF复发方面与MCN一样有效，且具有更高安全性，并发症更少，透视时间更短。
