Li Runkai, Zhang Xuefang, Liu Xiao, Gu Zhenbang, He Jiangui, Dong Yugang, Chen Yili, Lip Gregory Y H, Liu Chen, Zhu Wengen
Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China.
Department of Cardiology, Jiangmen Central Hospital, Jiangmen, PR China.
JACC Asia. 2024 Nov 26;5(1):143-157. doi: 10.1016/j.jacasi.2024.09.014. eCollection 2025 Jan.
As a competitive nonthermal energy technique used in atrial fibrillation (AF), the effectiveness and safety of pulsed field ablation (PFA) has remained uncertain.
The authors meta-analysis aimed to investigate the effectiveness and safety of PFA in treating AF patients and compare its outcomes with conventional thermal ablation.
The PubMed, Embase, and Cochrane Library databases were systematically searched until January 2024 for relevant studies investigating the use of PFA for AF. A fixed-effects model was used for pooled analysis if the I value was <50%; otherwise, a random-effects model was applied.
A total of 46 studies were included in this analysis. The single-arm meta-analysis of 40 studies showed an acute pulmonary vein isolation (PVI) rate of 99.79% per pulmonary vein (PV) and 99.47% per patient, with atrial arrhythmia recurrence rates of 12.36%, 12.42%, and 23.28% at 3, 6, and 12 months, respectively. The safety outcomes incidence was low. In the comparison of 21 studies between PFA and thermal ablation, PFA demonstrated comparable acute PVI rates but a higher first-pass isolation rate. PFA was associated with a lower incidence of atrial arrhythmia recurrence after 3 months and phrenic nerve paralysis or injury, but a higher risk of cardiac perforation or tamponade. Procedure time was shorter with PFA.
PFA showed noninferiority to thermal ablation in acute PVI and superiority in first-pass isolation, atrial arrhythmia recurrence, phrenic nerve paralysis or injury, and procedure time. However, PFA treatment exhibited a higher risk of cardiac perforation or tamponade.
作为用于心房颤动（AF）的一种竞争性非热能技术，脉冲场消融（PFA）的有效性和安全性仍不确定。
作者进行的荟萃分析旨在研究PFA治疗AF患者的有效性和安全性，并将其结果与传统热消融进行比较。
系统检索PubMed、Embase和Cochrane图书馆数据库，直至2024年1月，以查找有关使用PFA治疗AF的相关研究。如果I值<50%，则使用固定效应模型进行汇总分析；否则，应用随机效应模型。
本分析共纳入46项研究。对40项研究的单臂荟萃分析显示，每条肺静脉（PV）的急性肺静脉隔离（PVI）率为99.79%，每位患者的PVI率为99.47%，在3、6和12个月时房性心律失常复发率分别为12.36%、12.42%和23.28%。安全结局发生率较低。在PFA与热消融的21项研究比较中，PFA显示出相当的急性PVI率，但首次隔离率更高。PFA与3个月后房性心律失常复发以及膈神经麻痹或损伤的发生率较低相关，但心脏穿孔或心包填塞的风险较高。PFA的手术时间更短。
PFA在急性PVI方面不劣于热消融，在首次隔离、房性心律失常复发、膈神经麻痹或损伤以及手术时间方面具有优势。然而，PFA治疗表现出较高的心脏穿孔或心包填塞风险。
