三维电解剖标测引导下零透视或近零透视导管消融治疗小儿心律失常的安全性和可行性：荟萃分析
Safety and feasibility of 3D-electroanatomical mapping-guided zero or near-zero fluoroscopy catheter ablation for pediatric arrhythmias: Meta-analysis.
作者信息
Prana Jagannatha Gusti Ngurah, Antara I Made Putra Swi, Kosasih Anastasya Maria, Adrian Jonathan, Mendel Brian, Labi Nikita Pratama Toding, Aji Wingga Chrisna, de Liyis Bryan Gervais, Tangkas Made Refika Widya Apsari, Cardia Yosep Made Pius, Alamsyah Alif Hakim
机构信息
Faculty of Medicine Udayana University/Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar Bali Indonesia.
Division of Electrophysiology and Cardiac Pacing, Department of Cardiology and Vascular Medicine Udayana University/Prof. Dr. I.G.N.G Ngoerah General Hospital Denpasar Bali Indonesia.
出版信息
J Arrhythm. 2024 May 16;40(4):913-934. doi: 10.1002/joa3.13062. eCollection 2024 Aug.
BACKGROUND
Catheter ablation in the pediatric population using fluoroscopy has been known to cause adverse events. This study aims to assess the effectiveness and safety of zero fluoroscopy (ZF) and near-ZF-guided catheter ablation for the treatment of arrhythmias in the pediatric population.
METHODS
The PubMed, Embase, and Cochrane library databases were searched and reviewed for relevant studies. Outcomes of interest include safety, short-term, and long-term effectiveness. We classified patients ≤21 years old who underwent ZF or near-ZF ablation with fluoroscopy time ≤1.5 min as our study group and patients within the same age range who underwent conventional fluoroscopy and/or near-ZF ablation with a mean fluoroscopy time >1.5 min as our control group. Both ZF and near-ZF ablation utilized 3D-electroanatomical mapping (3D-EAM).
RESULTS
Ten studies composed of 2279 patients were included in this study. Total fluoroscopy time (MD -15.93 min, 95% CI (-22.57 - (-9.29), < .001; = 84%)) and total procedural time (MD -22.06 min, 95% CI (-44.39 - (-0.28), < .001; = 88%)) were significantly lower in the near-ZF group. Both ZF and near-ZF demonstrated a trend towards improved success rates compared to conventional fluoroscopy but did not achieve statistical significance for all subgroup analyses. Ablation in the study group also decreased incidence of complication compared to the control (RR 0.35; 95% CI (0.14-0.90); = .03; = 0%).
CONCLUSION
ZF and near-ZF ablation reduced the overall duration, compares in effectiveness, and shows a superior safety profile compared to control group.
背景
已知使用荧光透视法在儿科人群中进行导管消融会导致不良事件。本研究旨在评估零荧光透视（ZF）和近零荧光透视引导下的导管消融治疗儿科人群心律失常的有效性和安全性。
方法
检索并回顾了PubMed、Embase和Cochrane图书馆数据库中的相关研究。感兴趣的结果包括安全性、短期和长期有效性。我们将年龄≤21岁、接受荧光透视时间≤1.5分钟的ZF或近ZF消融的患者分类为研究组，将年龄范围相同、接受传统荧光透视和/或平均荧光透视时间>1.5分钟的近ZF消融的患者分类为对照组。ZF和近ZF消融均采用三维电解剖标测（3D-EAM）。
结果
本研究纳入了10项由2279例患者组成的研究。近ZF组的总荧光透视时间（MD -15.93分钟，95%CI（-22.57 - （-9.29），<0.001；I² = 84%））和总手术时间（MD -22.06分钟，95%CI（-44.39 - （-0.28），<0.001；I² = 88%））显著更低。与传统荧光透视相比，ZF和近ZF均显示出成功率提高的趋势，但在所有亚组分析中均未达到统计学意义。与对照组相比，研究组的消融也降低了并发症的发生率（RR 0.35；95%CI（0.14 - 0.90）；P = 0.03；I² = 0%）。
结论
与对照组相比，ZF和近ZF消融缩短了总体持续时间，有效性相当，且安全性更高。
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