Department of Anesthesiology, Ninghua County General Hospital, Sanming, China.
Department of Cardiovascular Surgery Nursing, Fujian Medical University Union Hospital, Fuzhou, China.
Pacing Clin Electrophysiol. 2024 May;47(5):603-613. doi: 10.1111/pace.14971. Epub 2024 Mar 25.
The available data on the treatment strategy of pulsed field ablation (PFA) for patients with atrial fibrillation (AF) is limited. This study aims to provide a comparative analysis of the efficacy, safety, and procedural efficiency between PFA and cryoballoon ablation (CBA) for AF.
We conducted a comprehensive search of the EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov databases to identify trials comparing PFA with CBA for AF from their inception until December 2023. The odds ratio (OR) and mean difference (MD), along with a 95% confidence interval (CI), were utilized as measures of treatment effect.
The analysis included 15 eligible trials with a total enrollment of 1880 patients. No significant differences were found in recurrent atrial arrhythmia (OR 0.83, 95% CI 0.64, 1.07) or periprocedural complications (OR 0.78, 95% CI 0.46, 1.30) between the two ablation techniques examined in this study. However, the PFA technique demonstrated a significantly shorter procedure time (MD -7.17, 95% CI -13.60, -0.73), but a longer fluoroscopy time (MD 2.53, 95% CI 0.87, 4.19). Similarly, PFA was found to be significantly associated with a decreased incidence of phrenic nerve palsy (OR 0.20, 95% CI 0.07, 0.59), but an increased incidence of cardiac tamponade (OR 4.07, 95% CI 1.15, 14.39). Moreover, there was a significantly higher release of troponin with PFA compared to CBA (MD 470.28, 95% CI 18.89, 921.67), while the increase in S100 protein and heart rate was significantly lower with PFA than with CBA (MD -64.41, 95% CI -105.46, -17.36), (MD -8.76, 95% CI -15.12, -2.40).
The utilization of PFA provides a safer, time-saving, and tissue-specific procedure compared to CBA, while maintaining comparable success rates. This has the potential to enhance procedural efficiency and optimize resource utilization in clinical practice. These findings underscore the feasibility and promise of PFA as an alternative technique for PVI in patients with AF.
目前关于心房颤动（AF）患者脉冲场消融（PFA）治疗策略的可用数据有限。本研究旨在比较 PFA 与冷冻球囊消融（CBA）治疗 AF 的疗效、安全性和程序效率。
我们全面检索了 EMBASE、PubMed、Cochrane 图书馆和 ClinicalTrials.gov 数据库，以确定自成立以来至 2023 年 12 月比较 PFA 与 CBA 治疗 AF 的试验。采用比值比（OR）和均数差值（MD）及其 95%置信区间（CI）作为治疗效果的衡量指标。
该分析纳入了 15 项符合条件的试验，共纳入 1880 例患者。在复发性房性心律失常（OR 0.83，95%CI 0.64，1.07）或围手术期并发症（OR 0.78，95%CI 0.46，1.30）方面，两种消融技术之间未发现显著差异。然而，PFA 技术的手术时间明显更短（MD-7.17，95%CI-13.60，-0.73），但透视时间更长（MD 2.53，95%CI 0.87，4.19）。同样，与 CBA 相比，PFA 明显与膈神经麻痹发生率降低相关（OR 0.20，95%CI 0.07，0.59），但心脏压塞发生率增加（OR 4.07，95%CI 1.15，14.39）。此外，与 CBA 相比，PFA 组肌钙蛋白释放显著升高（MD 470.28，95%CI 18.89，921.67），而 PFA 组 S100 蛋白和心率升高幅度明显低于 CBA 组（MD-64.41，95%CI-105.46，-17.36），（MD-8.76，95%CI-15.12，-2.40）。
与 CBA 相比，PFA 提供了一种更安全、更省时且具有组织特异性的手术，同时保持相当的成功率。这有可能提高临床实践中的程序效率并优化资源利用。这些发现强调了 PFA 作为 AF 患者 PVI 的替代技术的可行性和前景。
