Radiofrequency and Cryoablation as Energy Sources in the Cox-Maze Procedure: A Meta-Analysis of Rhythm Outcomes.

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation Pub Date : 2024-12-14 DOI:10.1016/j.hlc.2024.10.014

Massimo Baudo, Fabrizio Rosati, Michele D'Alonzo, Stefano Benussi, Claudio Muneretto, Lorenzo Di Bacco

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引用次数: 0

Abstract

Aim: Cox-maze IV is the most effective surgical procedure for atrial fibrillation (AF) treatment to date; however, few studies have compared the outcomes of the different energy sources applied to achieve transmurality. This study aimed to analyse the impact of the different energy sources on Cox-maze IV results in terms of sinus rhythm restoration.

Method: A systematic review and meta-analysis was conducted by including studies reporting rhythm outcomes on biatrial Cox-maze AF ablation with bipolar radio-frequency (BRF), cryoenergy (Cryo), or both (BRF+Cryo). The primary endpoints were the early and late rhythm outcomes of AF ablation using the different energy sources. Late AF recurrences were evaluated through timepoint analysis, and freedom from AF from Kaplan-derived data. Sixty articles including 8,293 patients were selected (3,364 patients Cryo, 1,937 BRF, and 2,992 BRF+Cryo).

Results: At 6 months, AF incidence was significantly lower in the Cryo group at 6.73%; it was 25.52% in the BRF and 16.79% in the BRF+Cryo groups (p=0.0112). At the 4-year timepoint, AF incidence was lower in the Cryo group compared with the BRF and BRF+Cryo: 6.14% vs 51.59% vs 16.09%, respectively (p=0.0392). Freedom from AF was 76.7%±2.2%, 60.9%±2.2%, and 66.3%±1.6% for Cryo, BRF, and BRF+Cryo at 4 years, respectively (p<0.001). At meta-regression, mean left atrial diameter was positively associated with higher AF recurrences (OR 1.04, 95% CI 1.01-1.08; p=0.0159).

Conclusion: When performing this procedure, cryoablation seems to be associated with improved rhythm outcomes when compared with bipolar radiofrequency ablation.

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射频和冷冻消融作为 Cox-Maze 手术的能量来源：节律结果的 Meta 分析。

目的：Cox-maze IV 是迄今为止治疗心房颤动（房颤）最有效的手术方法；然而，很少有研究比较不同能量源在实现横跨性方面的效果。本研究旨在从恢复窦性心律的角度分析不同能量源对 Cox-maze IV 效果的影响：方法：通过纳入报告双极射频（BRF）、冷冻能量（Cryo）或两者（BRF+Cryo）对双房 Cox-maze 房颤消融术的节律结果的研究，进行了系统性回顾和荟萃分析。主要终点是使用不同能量源进行房颤消融的早期和晚期节律结果。晚期房颤复发通过时间点分析进行评估，房颤自由度则通过卡普兰衍生数据进行评估。共选取了60篇文章，包括8293名患者（3364名患者为低温消融，1937名患者为BRF消融，2992名患者为BRF+低温消融）：6个月后，低温组房颤发生率明显降低，为6.73%；BRF组为25.52%，BRF+Cryo组为16.79%（P=0.0112）。在 4 年的时间节点上，低温组的房颤发生率低于 BRF 组和 BRF+Cryo 组：分别为 6.14% vs 51.59% vs 16.09%（P=0.0392）。4年后，低温组、BRF组和BRF+Cryo组的房颤发生率分别为76.7%±2.2%、60.9%±2.2%和66.3%±1.6%（P结论：与双极射频消融术相比，冷冻消融术似乎能改善心律的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.50

自引率

3.80%

发文量

912

审稿时长

11.9 weeks

期刊介绍： Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.