Wan Yun, Zeng Shuting, Liu FuWei, Gao Xin, Li Weidong, Liu Kaifeng, He Jie, Ji Jianqing, Luo Jun
From the Department of Cardiology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, China.
Cardiol Rev. 2024 Nov 14. doi: 10.1097/CRD.0000000000000808.
Pulsed field ablation (PFA) is a novel nonthermal ablation technique for the treatment of atrial fibrillation (AF) patients, with safety comparable to traditional catheter ablation surgery. The present study aims to evaluate and compare the procedural efficiency and safety profiles of PFA and cryoballoon ablation (CBA) in the management of AF. We performed a systematic search across PubMed, the Cochrane Library, and Embase databases, encompassing the literature up to February 2024, to inform our systematic review and meta-analysis. When assessing outcome indicators, the risk ratio and its corresponding 95% confidence interval (CI) were calculated for dichotomous variables. For continuous variables, the mean difference (MD) and the associated 95% CI were determined. In this scenario, a relative risk (RR) value of less than 1 and an MD value of less than 0 are deemed favorable for the PFA group. This could translate to a reduced likelihood of procedural complications or enhanced procedural performance within the PFA group. In this analysis, 9 observational studies encompassing 2875 patients with AF were included. Among these, 38% (n = 1105) were treated with PFA, while 62% (n = 1770) received CBA. The results indicated that PFA was associated with a significantly shorter procedural duration compared with CBA, with an MD of -10.49 minutes (95% CI, -15.50 to -5.49; P < 0.0001). Nevertheless, no statistically significant differences were observed when comparing the 2 treatment cohorts concerning fluoroscopy time (MD, 0.71; 95% CI, -0.45 to 1.86; P = 0.23) and the recurrence of atrial arrhythmias during follow-up (RR, 0.95; 95% CI, 0.78-1.14; P = 0.57). In terms of perioperative complications, the PFA group showed a significantly decreased risk of phrenic nerve palsy (RR, 0.15; 95% CI, 0.06-0.39; P < 0.0001) and an increased risk of cardiac tamponade (RR, 3.48; 95% CI, 1.26-9.66; P = 0.02) compared with the CBA group. No significant differences were noted between the PFA and CBA groups regarding the incidence of stroke/transient ischemic attack (RR, 0.99; 95% CI, 0.30-3.22; P = 0.99), vascular access complication (RR, 0.87; 95% CI, 0.36-2.10; P = 0.76), atrial esophageal fistula (RR, 0.33; 95% CI, 0.01-8.13; P = 0.50), and major or minor bleeding events (RR, 0.39; 95% CI, 0.09-1.74; P = 0.22). Our research results indicate that compared with CBA, PFA not only shortens the procedure time but also demonstrates noninferiority in terms of fluoroscopy duration and the recurrence rate of atrial arrhythmias. PFA and CBA have both demonstrated their respective advantages in perioperative complications.
脉冲场消融（PFA）是一种用于治疗心房颤动（AF）患者的新型非热消融技术，其安全性与传统导管消融手术相当。本研究旨在评估和比较PFA与冷冻球囊消融（CBA）在房颤治疗中的手术效率和安全性。我们在PubMed、Cochrane图书馆和Embase数据库中进行了系统检索，涵盖截至2024年2月的文献，以支持我们的系统评价和荟萃分析。在评估结果指标时，计算二分变量的风险比及其相应的95%置信区间（CI）。对于连续变量，确定平均差（MD）和相关的95%CI。在这种情况下，PFA组的相对风险（RR）值小于1且MD值小于0被认为是有利的。这可能意味着PFA组手术并发症的可能性降低或手术表现增强。在这项分析中，纳入了9项观察性研究，共2875例房颤患者。其中，38%（n = 1105）接受了PFA治疗，而6
