脉冲场消融治疗心房颤动的安全性和有效性及其与传统热消融的比较：一项系统评价和荟萃分析
Safety and Efficacy of Pulse Field Ablation in the Treatment of Atrial Fibrillation and Its Comparison with Traditional Thermal Ablation: A Systematic Review and Meta-Analysis.
作者信息
Gong Aobo, Li Wentao, Li Fanghui, Tong Yao, Cao Ying, Zeng Rui
机构信息
Department of Cardiology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
出版信息
Rev Cardiovasc Med. 2024 Nov 21;25(11):415. doi: 10.31083/j.rcm2511415. eCollection 2024 Nov.
BACKGROUND
The purpose of this meta-analysis was to evaluate the efficacy and safety of pulsed field ablation (PFA) and to compare it with the efficacy and safety of traditional thermal ablation in patients with atrial fibrillation (AF).
METHODS
PubMed, Web of Science, and Embase were searched for randomized or observational studies exploring the efficacy and safety of PFA and comparing PFA with traditional thermal ablation in patients with AF.
RESULTS
A total of 4437 patients from 16 studies that only included PFA as the ablation method and 1792 patients from 9 comparing PFA to traditional thermal ablation were included in the final analysis. In studies that considered PFA alone, the freedom from atrial arrhythmia recurrence was 0.80 (95% confidence interval [CI] 0.76-0.84), and the incidence of periprocedural complications was 0.03 (95% CI 0.02-0.05). In comparative studies, there was no significant difference in the freedom from atrial arrhythmia recurrence (odds ratio (OR) 1.24, 95% CI 0.90-1.72) and the incidence of periprocedural complications (OR 0.74, 95% CI 0.37-1.48) of PFA compared to that of traditional thermal ablation. In the subgroup with a follow-up period less than 12 months, PFA had higher freedom from atrial arrhythmia recurrence rate compared to thermal ablation (OR 2.19, 95% CI 1.14-4.20).
CONCLUSIONS
PFA is a safe and effective catheter ablation method that is not inferior to the traditional and well-established thermal ablation. It can be used as a treatment of choice for patients with AF.
THE PROSPERO REGISTRATION
CRD42023473026, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026.
背景
本荟萃分析的目的是评估脉冲场消融（PFA）的疗效和安全性，并将其与传统热消融治疗心房颤动（AF）患者的疗效和安全性进行比较。
方法
检索PubMed、Web of Science和Embase，查找探索PFA疗效和安全性以及比较PFA与传统热消融治疗AF患者的随机或观察性研究。
结果
最终分析纳入了16项仅将PFA作为消融方法的研究中的4437例患者，以及9项比较PFA与传统热消融的研究中的1792例患者。在仅考虑PFA的研究中，房性心律失常复发的自由度为0.80（95%置信区间[CI]0.76 - 0.84），围手术期并发症发生率为0.03（95%CI 0.02 - 0.05）。在比较性研究中，与传统热消融相比，PFA在房性心律失常复发自由度（优势比[OR]1.24，95%CI 0.90 - 1.72）和围手术期并发症发生率（OR 0.74，95%CI 0.37 - 1.48）方面无显著差异。在随访期小于12个月的亚组中，与热消融相比，PFA的房性心律失常复发自由度更高（OR 2.19，95%CI 1.14 - 4.20）。
结论
PFA是一种安全有效的导管消融方法，并不逊色于传统且成熟的热消融。它可作为AF患者的首选治疗方法。
PROSPERO注册：CRD42023473026，https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026 。
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