冷冻球囊与射频消融治疗心房颤动后心肌损伤和炎症生物标志物的比较及其对复发的影响：一项系统评价和荟萃分析
Comparison of Myocardial Injury and Inflammation Biomarkers and Their Impact on Recurrence after Cryoballoon and Radiofrequency Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis.
作者信息
Zhou Xinbin, Xue Hong, Chen Qian, Lv Zhengtian, Mao Wei, Wang Xiao
机构信息
Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Key Laboratory of Integrative Chinese and Western Medicine for the Diagnosis and Treatment of Circulatory Diseases of Zhejiang Province, 310006 Hangzhou, Zhejiang, China.
Department of Cardiology, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), 266000 Qingdao, Shandong, China.
出版信息
Rev Cardiovasc Med. 2022 Dec 7;23(12):397. doi: 10.31083/j.rcm2312397. eCollection 2022 Dec.
BACKGROUND
Biomarkers of myocardial injury and inflammation were found to be different after radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA) for atrial fibrillation (AF); however, the results are currently controversial. This study was aimed to systematically compare the differences in myocardial injury and inflammation biomarkers after RFCA and CBA procedures and to investigate their impact on AF recurrence.
METHODS
Databases, including PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM), were systematically searched from their date of inception to May 2022. The primary outcomes of interest were the differences in myocardial injury and inflammation biomarkers after CBA and RFCA procedures for AF patients, and the impact of the biomarkers on AF recurrence. Secondary outcomes included the total ablation time, the procedure duration and the freedom from atrial tachycardia (AT).
RESULTS
Eighteen studies with a total of 1807 patients were finally enrolled. CBA treatment was associated with significantly greater increases in troponin I (TNI) levels (weighted mean difference [WMD] = 3.13 ug/L, 95% confidence interval [CI] 2.43-3.64) both at 4-6 h (WMD = 3.94 ug/L), 24 h (WMD = 4.23 ug/L), 48 h (WMD = 2.14 ug/L) and 72 h (WMD = 0.56 ug/L), and also creatine kinade MB fraction (CK-MB) levels at 4-6 h (WMD = 33.21 U/L), 24 h (WMD = 35.84 U/L) and 48 h (WMD = 4.62 U/L), while RFCA treatment was associated with greater increases in postablation C-reactive protein (CRP) levels both at 48 h (WMD = -9.32 mg/L) and 72 h (WMD = -10.90 mg/L). The CBA and RFCA treatments had comparable rates of freedom from AT (74.5% vs. 75.2%, RR = 1.08). The CRP levels were significantly higher in patients with early recurrence of AF (ERAF) than in those without ERAF after RFCA treatment (WMD = 3.415 mg/L).
CONCLUSIONS
The time-course patterns of postablation myocardial injury and inflammation biomarkers are different between RFCA and CBA procedures. The lower postprocedural elevation of myocardial injury biomarkers and the increased CRP levels may be predictive factors for ERAF.
PROSPERO REGISTRATION NUMBER
CRD42021278564.
背景
在心房颤动（AF）的射频导管消融（RFCA）和冷冻球囊消融（CBA）术后，心肌损伤和炎症生物标志物存在差异；然而，目前结果存在争议。本研究旨在系统比较RFCA和CBA术后心肌损伤和炎症生物标志物的差异，并探讨其对房颤复发的影响。
方法
系统检索包括PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov、中国知网（CNKI）和中国生物医学文献数据库（CBM）在内的数据库，检索时间从建库至2022年5月。主要关注的结果是房颤患者CBA和RFCA术后心肌损伤和炎症生物标志物的差异，以及这些生物标志物对房颤复发的影响。次要结果包括总消融时间、手术持续时间和房性心动过速（AT）的发生率。
结果
最终纳入18项研究，共1807例患者。CBA治疗与肌钙蛋白I（TNI）水平在4 - 6小时（加权平均差[WMD]=3.94μg/L）、24小时（WMD = 4.23μg/L）、48小时（WMD = 2.14μg/L）和72小时（WMD = 0.56μg/L）显著升高相关，同时与肌酸激酶同工酶MB（CK-MB）水平在4 - 6小时（WMD = 33.21 U/L）、24小时（WMD = 35.84 U/L）和48小时（WMD = 4.62 U/L）显著升高相关；而RFCA治疗与消融后C反应蛋白（CRP）水平在48小时（WMD = -9.32 mg/L）和72小时（WMD = -10.90 mg/L）显著升高相关。CBA和RFCA治疗的房性心动过速发生率相当（74.5%对75.2%，相对危险度[RR]=1.08）。RFCA治疗后房颤早期复发（ERAF）患者的CRP水平显著高于无ERAF患者（WMD = 3.415 mg/L）。
结论
RFCA和CBA术后消融后心肌损伤和炎症生物标志物的时间进程模式不同。术后心肌损伤生物标志物较低的升高水平和CRP水平的升高可能是ERAF的预测因素。
国际前瞻性系统评价注册编号
CRD42021278564。
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