Amin Ahmed Mazen, Nawlo Ahmad, Ibrahim Ahmed A, Hassan Ahmed, Saber Alhassan, Abuelazm Mohamed, Abdelazeem Basel
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Division of Infectious Diseases, Brigham and Women's Hospital- Harvard Medical School, Boston, MA, 02115, USA.
Egypt Heart J. 2024 Jul 8;76(1):89. doi: 10.1186/s43044-024-00518-x.
Persistent Atrial Fibrillation (PeAF) is a challenging case for rhythm control modalities. Catheter ablation is the mainstay in PeAF management; however, data regarding the comparative safety and efficacy of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for PeAF is still limited. We aim to compare the safety and efficacy of CBA versus RFA for PeAF ablation.
We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through October 2023. RevMan version 5.4 software was used to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI).
CRD42023480314.
Three RCTs with 400 patients were included. There was no significant difference between RFA and CBA regarding AF recurrence (RR: 0.77, 95% CI [0.50, 1.20], P = 0.25), atrial tachycardia or atrial flutter recurrence (RR: 0.54, 95% CI [0.11, 2.76], P = 0.46), and any arrhythmia recurrence (RR: 0.96, 95% CI [0.70, 1.31], P = 0.80). CBA was significantly associated with decreased total procedure duration (MD: - 45.34, 95% CI [- 62.68, - 28.00], P < 0.00001), with no significant difference in fluoroscopy duration (MD: 3.59, 95% CI [- 5.13, 12.31], P = 0.42). Safety parameters were similar in both groups, including the incidence of any complications, phrenic nerve palsy (RR: 2.91 with 95% CI [0.31, 27.54], P = 0.35), access site complications (RR: 0.33 with 95% CI [0.05, 2.03], P = 0.23), and pericardial effusion.
In PeAF catheter ablation, CBA is comparable to RFA in terms of safety and efficacy. Also, CBA is associated with a shorter total procedure duration.
持续性心房颤动（PeAF）是节律控制模式中具有挑战性的病例。导管消融是PeAF治疗的主要手段；然而，关于冷冻球囊消融（CBA）与射频消融（RFA）治疗PeAF的比较安全性和有效性的数据仍然有限。我们旨在比较CBA与RFA治疗PeAF消融的安全性和有效性。
我们进行了一项系统评价和荟萃分析，综合随机对照试验（RCT），通过系统检索截至2023年10月的PubMed、EMBASE、科学网、SCOPUS和Cochrane获取这些试验。使用RevMan 5.4软件，采用风险比（RR）汇总二分数据，采用平均差（MD）及95%置信区间（CI）汇总连续数据。
PROSPERO注册号：CRD42023480314。
纳入了3项随机对照试验，共400例患者。在房颤复发（RR：0.77，95%CI[0.50，1.20]，P = 0.25）、房性心动过速或心房扑动复发（RR：0.54，95%CI[0.11，2.76]，P = 0.46）以及任何心律失常复发（RR：0.96，95%CI[0.70，1.31]，P = 0.80）方面，RFA和CBA之间无显著差异。CBA与总手术时间缩短显著相关（MD：- 45.34，95%CI[- 62.68，- 28.00]，P < 0.00001），透视时间无显著差异（MD：3.59，95%CI[- 5.13，12.31]，P = 0.42）。两组的安全性参数相似，包括任何并发症的发生率、膈神经麻痹（RR：2.91，95%CI[0.31，27.54]，P = 0.35）、穿刺部位并发症（RR：0.33，95%CI[0.05，2.03]，P = 0.23）以及心包积液。
在PeAF导管消融中，CBA在安全性和有效性方面与RFA相当。此外，CBA与较短的总手术时间相关。
