Kim Jitae A, Chelu Mihail G
Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.
Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
J Interv Card Electrophysiol. 2023 Apr;66(3):585-595. doi: 10.1007/s10840-022-01369-9. Epub 2022 Sep 12.
There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF.
A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects.
One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48 months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I 0%). Shorter procedure times were observed with CB (mean reduction 43.77 min, 95% CI 66.45 to 21.09 min, I 96%) with no difference in fluoroscopy time (mean difference 0.82 min, 95% CI - 11.92 to 13.55 min, I 100%).
In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.
关于持续性心房颤动（房颤）的射频（RF）消融与冷冻球囊（CB）消融对比的数据有限，与阵发性房颤相比，持续性房颤消融后的复发率往往更高。
对Embase、PubMed和Cochrane数据库进行系统检索，以查找比较持续性房颤的RF消融与CB消融的研究。采用逆方差随机效应模型计算综合效应。
共识别出1项随机对照研究和9项观察性研究，1650例患者接受CB消融，1706例患者接受RF消融。平均随访时间为12至48个月。两种消融方式的房性快速性心律失常复发率相似（风险比[HR]为0.93，95%置信区间[CI]为0.80至1.08，异质性[I²]为0%）。两组的总并发症相似（相对危险度[RR]为1.05，95%CI为0.73至1.53，I²为0%），尽管CB消融导致膈神经麻痹（PNP）的发生率更高（RR为4.13，95%CI为1.49至11.46，I²为0%）。CB消融的手术时间更短（平均缩短43.77分钟，95%CI为66.45至21.09分钟，I²为96%），透视时间无差异（平均差异为0.82分钟，95%CI为-11.92至13.55分钟，I²为100%）。
在持续性房颤患者中，CB消融与RF消融的疗效和总体安全性相似。虽然CB消融的手术时间显著缩短，但PNP发生率增加以及可能需要补充RF消融抵消了CB消融提高的手术效率。
