比较热球囊、激光球囊和冷冻球囊消融作为心房颤动初始治疗方法的贝叶斯网络荟萃分析。
Bayesian network meta-analysis comparing hot balloon, laser balloon and cryoballoon ablation as initial therapies for atrial fibrillation.
作者信息
Wu Chenxia, Hu Luoxia, Kong Youjin, Zhao Bowen, Mao Wei, Zhou Xinbin
机构信息
Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
出版信息
Front Cardiovasc Med. 2023 Jul 25;10:1184467. doi: 10.3389/fcvm.2023.1184467. eCollection 2023.
BACKGROUND
Balloon-based catheter ablation (CA) technologies, including hot balloon ablation (HBA), laser balloon ablation (LBA) and cryoballoon ablation (CBA) have been introduced in recent years as alternatives to conventional radiofrequency ablation therapy for atrial fibrillation (AF). However, the results remain controversial concerning the optimal approach. Thus, we conducted a network meta-analysis (NMA) to comprehensively evaluate the efficacy and safety of HBA, LBA and CBA.
METHODS
Clinical trials comparing the efficacy and safety of HBA, LBA and CBA were identified through a systematic search up to October 2022. The primary outcomes of interest were the recurrence of AF and procedure-related complications.
RESULTS
Twenty clinical trials with a total of 1,995 patients were included in the meta-analysis. The NMA results demonstrated that HBA, LBA and CBA had comparable AF recurrence rates (HBA vs. CBA: odds ratio OR = 0.88, 95% credible interval CrI: 0.56-1.4; LBA vs. CBA: OR = 1.1, 95% CrI: 0.75-1.5; LBA vs. HBA: OR = 1.2, 95% CrI: 0.70-2.0) and procedure-related complications (HBA vs. CBA: OR = 0.93, 95% CrI: 0.46-2.3; LBA vs. CBA: OR = 1.1, 95% CrI: 0.63-2.1; LBA vs. HBA: OR = 1.2, 95% CrI: 0.44-2.8). The surface under the cumulative ranking curve (SUCRA) suggested that HBA may be the optimal approach concerning the primary outcomes (SUCRA = 74.4%; 61.1%, respectively). However, HBA (40.1%) had a significantly higher incidence of touch-up ablation (TUA) than LBA (8.5%, OR = 2.8, 95% CrI: 1.1-7.1) and CBA (11.9%, OR = 3.7, 95% CrI: 1.9-7.5). LBA required more procedure time than CBA [mean difference (MD = 32.0 min, 95% CrI: 19.0-45.0 min)] and HBA (MD = 26.0 min, 95% CrI: 5.6-45.0 min), but less fluoroscopy time than HBA (MD = -9.4 min, 95% CrI: -17.0--2.4 min).
CONCLUSIONS
HBA, LBA and CBA had comparable efficacy and safety as initial treatments for AF. HBA ranked highest in the primary outcomes, but at the cost of a higher incidence of TUA and longer fluoroscopy time.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022381954, identifier: CRD42022381954.
背景
近年来，基于球囊的导管消融（CA）技术，包括热球囊消融（HBA）、激光球囊消融（LBA）和冷冻球囊消融（CBA）已作为心房颤动（AF）传统射频消融治疗的替代方法被引入。然而，关于最佳方法的结果仍存在争议。因此，我们进行了一项网状荟萃分析（NMA），以全面评估HBA、LBA和CBA的疗效和安全性。
方法
通过系统检索截至2022年10月的临床试验，比较HBA、LBA和CBA的疗效和安全性。感兴趣的主要结局是房颤复发和与手术相关的并发症。
结果
荟萃分析纳入了20项临床试验，共1995例患者。NMA结果表明，HBA、LBA和CBA的房颤复发率相当（HBA与CBA：优势比OR = 0.88，95%可信区间CrI：0.56 - 1.4；LBA与CBA：OR = 1.1，95% CrI：0.75 - 1.5；LBA与HBA：OR = 1.2，95% CrI：0.70 - 2.0）以及与手术相关的并发症（HBA与CBA：OR = 0.93，95% CrI：0.46 - 2.3；LBA与CBA：OR = 1.1，95% CrI：0.63 - 2.1；LBA与HBA：OR = 1.2，95% CrI：0.44 - 2.8）。累积排序曲线下面积（SUCRA）表明，就主要结局而言，HBA可能是最佳方法（SUCRA分别为74.4%；61.1%）。然而，HBA（40.1%）的补点消融（TUA）发生率显著高于LBA（8.5%，OR = 2.8，95% CrI：1.1 - 7.1）和CBA（11.9%，OR = 3.7，95% CrI：1.9 - 7.5）。LBA所需的手术时间比CBA [平均差值（MD = 32.0分钟，95% CrI：19.0 - 45.0分钟）]和HBA（MD = 26.0分钟，95% CrI：5.6 - 45.0分钟）长，但透视时间比HBA短（MD = -9.4分钟，95% CrI：-17.0 - -2.4分钟）。
结论
HBA、LBA和CBA作为AF的初始治疗方法，疗效和安全性相当。HBA在主要结局方面排名最高，但代价是TUA发生率较高和透视时间较长。
系统评价注册
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022381954，标识符：CRD42022381954。
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