阵发性心房颤动的脉冲场消融与射频消融：系统评价与荟萃分析

Pulsed-Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis.

作者信息

Martins Esteves Inês, de Pontes Vinicius Bittar, Trevisan Thierry, Jaramillo Sebastian, Gomes Wilton F

机构信息

School of Medicine and Biomedical Sciences University of Porto Porto Portugal.

Centro Universitário das Faculdades Associadas de Ensino São João da Boa Vista Brazil.

出版信息

J Arrhythm. 2025 Aug 4;41(4):e70158. doi: 10.1002/joa3.70158. eCollection 2025 Aug.

DOI:10.1002/joa3.70158

PMID:40761535

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12320123/

Abstract

BACKGROUND

Pulsed-field ablation (PFA) is a nonthermal alternative to radiofrequency ablation (RFA) for patients with atrial fibrillation (AF). However, the role of PFA compared to RFA in patients with paroxysmal AF (PAF) remains unclear.

OBJECTIVE

To compare the efficacy and safety of PFA and RFA in adult patients with PAF.

METHODS

A systematic review and meta-analysis were conducted following the Cochrane methodology and reported in accordance with PRISMA guidelines. The PubMed, Embase, and Cochrane databases were searched through February 2025 for studies comparing PFA and RFA in adults with PAF. The outcomes of interest included procedure time, 1-year success rate, and major complications. All the statistical analyses were performed via R version 4.5 with a random effects model.

RESULTS

One randomized controlled trial (RCT) and five observational studies comprising 3163 patients with PAF were included, of whom 972 (30.7%) underwent PFA. The follow-up time ranged from 12 to 30 months. PFA was associated with a significantly shorter procedure time (MD -39.15 min; 95% CI -58.19 to -20.11, < 0.01), but a significantly longer fluoroscopy time (MD 10.75 min; 95% CI 5.58-15.92, < 0.01) as compared with RFA. There were no statistically significant differences in terms of the 1-year success rate (RR 1.04; 95% CI 0.77-1.41, = 0.79) and major complications (RR 0.95; 95% CI 0.60-1.52, = 0.83) between PFA and RFA.

CONCLUSION

In this meta-analysis, PFA was associated with a reduced operative time and an increased fluoroscopy time, with comparable 1-year efficacy and overall safety profiles.

TRIAL REGISTRATION

PROSPERO number: CRD420251000165.

摘要

背景

对于心房颤动（AF）患者，脉冲场消融（PFA）是一种可替代射频消融（RFA）的非热消融方法。然而，与RFA相比，PFA在阵发性房颤（PAF）患者中的作用仍不明确。

目的

比较PFA和RFA在成年PAF患者中的疗效和安全性。

方法

按照Cochrane方法进行系统评价和荟萃分析，并根据PRISMA指南报告结果。检索了截至2025年2月的PubMed、Embase和Cochrane数据库，以查找比较PFA和RFA在成年PAF患者中的研究。感兴趣的结局包括手术时间、1年成功率和主要并发症。所有统计分析均通过R 4.5版本采用随机效应模型进行。

结果

纳入了一项随机对照试验（RCT）和五项观察性研究，共3163例PAF患者，其中972例（30.7%）接受了PFA。随访时间为12至30个月。与RFA相比，PFA的手术时间显著缩短（MD -39.15分钟；95%CI -58.19至-20.11，P<0.01），但透视时间显著延长（MD 10.75分钟；95%CI 5.58-15.92，P<0.01）。PFA和RFA在1年成功率（RR 1.04；95%CI 0.77-1.41，P=0.79）和主要并发症（RR 0.95；95%CI 0.60-1.52，P=0.83）方面无统计学显著差异。