Xu Jingmiao, Gao Ying, Liu Chunhui, Wang Yaping
Department of Cardiology the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Cardiovascular Key Lab of Zhejiang Province the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Cardiovasc Electrophysiol. 2022 May;33(5):897-907. doi: 10.1111/jce.15423. Epub 2022 Mar 4.
Intracardiac echocardiography (ICE) provides superior quality images and can monitor catheter location within the heart continuously. Given the limited evidence, we conducted the meta-analysis to evaluate outcomes with ICE in radiofrequency (RF) ablation of atrial fibrillation (AF).
PubMed/MEDLINE, Embase, and Cochrane were searched for studies reporting RF ablation for treatment of AF with the use of ICE versus without ICE and 12 studies were included. Sensitivity analyses limiting studies to ablation with the use of contact force (CF) catheters were conducted and subgroup analyses were performed according to the published year. In main analyses, RF ablation with ICE for treatment of AF was associated with significant reduction in total X-ray time (mean difference [MD], -9.80; 95% confidence interval [CI], -15.57 to -4.04; I = 99%; p < .01), total procedure time (MD, -17.65; 95% CI, -30.22 to -5.09; I = 89%; p < .01), and complications (relative risk [RR], 0.90; 95% CI, 0.87-0.92; I = 20%; p < .01) versus without ICE. The ICE-guided group tended to decrease total absorbed X-ray dose (standardized mean difference, -0.91; 95% CI, -1.86 to 0.04; I = 96%; p = .06). Freedom from arrhythmia (RR, 1.06; 95% CI, 0.98-1.14; I = 0%; p = .13) was comparable between the two groups.
In patients with AF, ICE-guided RF ablation is correlated with significant reductions in total X-ray time, total procedure time, and complications versus ablation without ICE. Total absorbed X-ray dose tends to reduce in the ICE group and freedom from arrhythmia is comparable between the two groups.
心腔内超声心动图（ICE）可提供高质量图像，并能持续监测心脏内导管位置。鉴于证据有限，我们进行了荟萃分析以评估ICE在心房颤动（AF）射频（RF）消融中的疗效。
检索了PubMed/MEDLINE、Embase和Cochrane数据库，查找报告使用ICE与不使用ICE进行AF射频消融治疗的研究，共纳入12项研究。进行了敏感性分析，将研究限制为使用接触力（CF）导管进行消融，并根据发表年份进行亚组分析。在主要分析中，与不使用ICE相比，使用ICE进行AF射频消融治疗可显著减少总X线照射时间（平均差值[MD]，-9.80；95%置信区间[CI]，-15.57至-4.04；I² = 99%；p < 0.01）、总手术时间（MD，-17.65；95% CI，-30.22至-5.09；I² = 89%；p < 0.01）和并发症（相对风险[RR]，0.90；95% CI，0.87 - 0.92；I² = 20%；p < 0.01）。ICE引导组的总吸收X线剂量有降低趋势（标准化平均差值，-0.91；95% CI，-1.86至0.04；I² = 96%；p = 0.06）。两组的无心律失常发生率（RR，1.06；95% CI，0.98 - 1.14；I² = 0%；p = 0.13）相当。
在AF患者中，与不使用ICE的消融相比，ICE引导下的RF消融与总X线照射时间、总手术时间和并发症的显著减少相关。ICE组的总吸收X线剂量有降低趋势，两组的无心律失常发生率相当。
