与标准技术相比，房颤冷冻消融单次治疗技术具有相当的有效性和安全性：来自多项临床研究的见解。
Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies.
作者信息
He Changjian, Zhang Wenchang, Yin Lei, Sun Mingzhuang, Zhao Zihan, Ye Guojie, Liu Tengfei, Shi Wence, Zhang Da, Li Feng, Ding Chunhua
机构信息
Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China.
Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
出版信息
Front Cardiovasc Med. 2023 Sep 7;10:1195492. doi: 10.3389/fcvm.2023.1195492. eCollection 2023.
BACKGROUND
Although there are many freezing protocols available, the optimal freezing dose is still not determined. We aimed to evaluate the effectiveness and safety of different freeze strategies of CBA in the treatment of AF.
METHODS
PubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st December 2022. Studies comparing the outcomes between single-shot technique and standard technique of cryoablation were included. Subgroup analysis identified potential determinants for single-shot technique procedure.
RESULTS
Our search resulted in 3407 records after deduplication. A total of 17 qualified studies met our inclusion criteria. Compared with standard technique, single-shot technique of cryoablation has a comparable rate of freedom from AF/AT(RR 1.00; = 0.968), a trend for lower rate of procedure complications (RR 0.80; = 0.069), a lower rate in transient phrenic paralysis (t-PNP) (RR 0.67; = 0.038), a similar rate in persistent phrenic paralysis (per-PNP) (RR 1.15; = 0.645), as well as a comparable procedure parameters. Importantly, potentially significant treatment covariable interactions in procedure complications were found in freeze strategy subgroup, male proportion subgroup and age subgroup, including single-shot freeze (RR 1.02; = 0.915) and TTI-guided (RR 0.63; = 0.007) with interaction = 0.051, high male proportion (RR 0.54; = 0.005) and a low male proportion (RR 0.94; = 0.759) with interaction = 0.074, as well as age ≥ 65 (RR0.91; = 0.642) and age <65 (RR 0.54; = 0.006),interaction = 0.090. Meanwhile, only one significant treatment covariable interactions in procedure complications was found in the hypertension subgroup, including HT > 60% (RR 0.89; = 0.549) and HT ≤ 60% (RR 0. 46; < 0.01) with interaction = 0.043.
CONCLUSIONS
Our study suggested that single-shot technique of cryoablation has comparable effective and safety outcomes for AF ablation compared to standard technique.
背景
尽管有多种冷冻方案可供选择，但最佳冷冻剂量仍未确定。我们旨在评估冷冻球囊消融术（CBA）不同冷冻策略治疗房颤（AF）的有效性和安全性。
方法
检索截至2022年12月1日的PubMed、Cochrane图书馆、科学网和Embase。纳入比较冷冻消融单次技术与标准技术疗效的研究。亚组分析确定了单次技术操作的潜在决定因素。
结果
我们的检索在去重后得到3407条记录。共有17项符合条件的研究满足我们的纳入标准。与标准技术相比，冷冻消融单次技术的房颤/房性心动过速（AF/AT）无复发率相当（风险比[RR]1.00；95%置信区间[CI]=0.968），手术并发症发生率有降低趋势（RR0.80；CI=0.069），短暂性膈神经麻痹（t-PNP）发生率较低（RR0.67；CI=0.038），持续性膈神经麻痹（per-PNP）发生率相似（RR1.15；CI=0.645），手术参数也相当。重要的是，在冷冻策略亚组、男性比例亚组和年龄亚组中发现了手术并发症中潜在的显著治疗协变量相互作用，包括单次冷冻（RR1.02；CI=0.915）和时间-温度积分（TTI）引导（RR0.63；CI=0.007），相互作用P=0.051，男性比例高（RR0.54；CI=0.005）和男性比例低（RR0.94；CI=0.759），相互作用P=0.074，以及年龄≥65岁（RR0.91；CI=0.642）和年龄<65岁（RR0.54；CI=0.006），相互作用P=0.090。同时，在高血压亚组中仅发现手术并发症中一个显著的治疗协变量相互作用，包括高血压（HT）>60%（RR0.89；CI=0.549）和HT≤60%（RR0.46；CI<0.01），相互作用P=0.043。
结论
我们的研究表明，与标准技术相比，冷冻消融单次技术在房颤消融中具有相当的有效性和安全性。
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