Reviews in cardiovascular medicine最新文献

{"title":"Comparison of Various Surgical Approaches for Moderate-to-Severe Ischemic Mitral Regurgitation: A Systematic Review and Network Meta-Analysis.","authors":"Zhili Wei, Shuai Dong, Xuhua Li, Yang Chen, Shidong Liu, Bing Song","doi":"10.31083/j.rcm2511425","DOIUrl":"https://doi.org/10.31083/j.rcm2511425","url":null,"abstract":"<p><strong>Background: </strong>This study aims to systematically review the efficacy of various surgical approaches in the treatment of ischemic mitral regurgitation (IMR).</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using computerized databases, including PubMed, Cochrane Library, Embase, and Web of Science, up to February 2024. In our network meta-analysis, we utilized the Cochrane Handbook tool for quality evaluation, while a consistency model and the odds ratio (OR) were used to compile and analyze the data from the studies included, employing Stata 17.0 software for this purpose.</p><p><strong>Results: </strong>The systematic review included a total of 20 randomized controlled trials (RCTs), which collectively involved 3111 patients and evaluated six different surgical techniques. The network meta-analysis demonstrated that mitral valve repair (MVr) exhibited a significant reduction in 30-day all-cause mortality rates when compared to coronary artery bypass grafting (CABG), mitral valve replacement (MVR), CABG combined with MVR, and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip. Furthermore, probability ranking analysis suggested that MVr may be the most effective approach in reducing 30-day all-cause mortality, while CABG combined with MVr had significantly fewer renal complications compared to CABG combined with MVR. Probability rankings also indicated that CABG+MVr may be the most effective technique in minimizing renal complications. However, there were no statistically significant differences observed in other outcome measures among the different surgical techniques.</p><p><strong>Conclusions: </strong>Current limited evidence indicates that CABG combined with MVr may be the best surgical approach for patients with IMR. However, these conclusions are tentative and require further confirmation from more additional high-quality studies.</p><p><strong>Inplasy registration number: </strong>INPLASY202420049. This study can be accessed at the following detailed address: https://inplasy.com/inplasy-2024-2-0049/, last accessed on February 11, 2024.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"425"},"PeriodicalIF":1.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and Social Connections as Determinants of Hypertension: A Systematic Review of Longitudinal Studies.","authors":"Annalijn I Conklin, Peter N Guo","doi":"10.31083/j.rcm2511424","DOIUrl":"https://doi.org/10.31083/j.rcm2511424","url":null,"abstract":"<p><strong>Background: </strong>Social connections impact cardiovascular diseases (CVD) morbidity and mortality, but their role in hypertension, as a CVD risk factor, and their gender inequities is less understood. This review aimed to examine the longitudinal evidence on the impact of changes in social connections on risk of hypertension among aging adults, with a specific focus on gender.</p><p><strong>Methods: </strong>A systematic search of peer-reviewed literature in Medline, Embase, Scopus, and CINAHL conducted until 10 June 2024. Prospective studies evaluating the effect of changes in living arrangement, marital status, social network, or social participation on changes in blood pressure or incident hypertension among adults aged 45 and above were included.</p><p><strong>Results: </strong>We found 20,026 records (13,381 duplicates), resulting in 6645 eligible titles/abstracts for screening and 29 texts read in full. Only six studies from three countries met inclusion criteria, with four focused on marital transitions and two on changes in living arrangement. Overall, loss of close social connections had mixed effects on changes in blood pressure or risk of hypertension. More consistent adverse CVD outcomes were observed across studies for aging adults who entered marriage or became co-living (gain of close social connections). Similarly, persistent lack of close social connections appeared to result in greater increases in blood pressure or higher risk of hypertension. Two included studies were of high quality and the rest were medium quality. Excluded studies assessing change in either CVD risk or social tie transitions were also described (n = 9).</p><p><strong>Conclusions: </strong>There is a surprising paucity of prospective evidence on social relationships as determinants of CVD risk in the aging population, despite ample research on social factors correlated with health. Limited research suggests that both gains and losses of close social connections as well as persistent lack of close social connections may alter CVD risk, but effects are specific to single-sex samples. Research and policy should prioritize causally robust high-quality studies to unravel social determinants of CVD risk as actionable evidence to inform social prescribing in CVD prevention and healthy aging strategies is still tenuous.</p><p><strong>The prospero registration: </strong>CRD42022373196, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373196.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"424"},"PeriodicalIF":1.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictive Value of Fibrinogen-to-Albumin Ratio for Predicting Intravenous Immunoglobulin Resistance in Kawasaki Disease: A Prospective Cohort Study.","authors":"Yaru Cui, Linling Zhang, Xiaoliang Liu, Lei Liu, Kaiyu Zhou, Yimin Hua, Shuran Shao, Chuan Wang","doi":"10.31083/j.rcm2511421","DOIUrl":"https://doi.org/10.31083/j.rcm2511421","url":null,"abstract":"<p><strong>Background: </strong>Predicting resistance to intravenous immunoglobulin (IVIG) in the treatment of Kawasaki disease (KD) remains a focus of research. Fibrinogen and albumin in systemic inflammation play an important role. This study aims to investigate the predictive value of fibrinogen to albumin ratio (FAR) for initial IVIG resistance in patients with KD.</p><p><strong>Methods: </strong>The study prospectively recruited 962 patients with KD between July 2015 and June 2022. The serum characteristics of the two groups were compared by comparing fibrinogen and albumin, as well as other laboratory and clinical data between the IVIG-responsive and IVIG-resistant groups. Multivariate logistic regression was used to explore the relationship between FAR and IVIG resistance. Receiver operating characteristic (ROC) curves were used to determine the effectiveness of FAR in predicting initial IVIG resistance.</p><p><strong>Results: </strong>Our results demonstrated that IVIG-resistant patients had significantly higher fibrinogen levels (603.35 ± 99.00 mg/L), FAR (17.30 ± 3.31), and lower albumin (35.47 ± 5.24 g/L) compared to IVIG-responsive patients (fibrinogen 572.35 ± 145.75 mg/L; FAR 15.08 ± 4.32; albumin 38.52 ± 4.55 g/L). 15.20 was the best cut-off value of FAR for predicting initial IVIG resistance. The sensitivity was 72.5%, the specificity was 51.3%, the positive predictive value was 91.8%, and the negative predictive value was 20.0%. Multivariate logistic regression analysis, found that FAR was an independent predictor of initial IVIG resistance in KD children.</p><p><strong>Conclusions: </strong>The FAR was an independent risk factor for initial IVIG resistance, its predictive power for initial IVIG resistance exceeded that of albumin and fibrinogen alone. FAR may not be suitable as a single marker but might serve as a complementary laboratory marker to accurately predict initial IVIG resistance in KD.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"421"},"PeriodicalIF":1.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation.","authors":"Jonas Rusnak, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Alexander Schmitt, Muharrem Akin, Péter Tajti, Kambis Mashayekhi, Mohamed Ayoub, Michael Behnes, Ibrahim Akin","doi":"10.31083/j.rcm2511420","DOIUrl":"https://doi.org/10.31083/j.rcm2511420","url":null,"abstract":"<p><strong>Background: </strong>There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS.</p><p><strong>Methods: </strong>Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised <i>t</i>-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman's correlation, Kaplan-Meier survival analyses, and Cox regression.</p><p><strong>Results: </strong>A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH₂O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank <i>p</i> = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank <i>p</i> = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH₂O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank <i>p</i> = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank <i>p</i> = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH₂O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; <i>p</i> = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952-2.438; <i>p</i> = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (<i>p</i> = 0.003).</p><p><strong>Conclusions: </strong>In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days.</p><p><strong>Clinical trial registration: </strong>NCT05575856, https://clinicaltrials.gov/study/NCT05575856.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"420"},"PeriodicalIF":1.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucose Metabolism Reprogramming of Vascular Endothelial Cells and Its Implication in Development of Atherosclerosis.","authors":"Shiwen Luo, Liu Li, Huiqing Chen, Jingyue Wei, Dongmei Yang","doi":"10.31083/j.rcm2511423","DOIUrl":"https://doi.org/10.31083/j.rcm2511423","url":null,"abstract":"<p><p>Atherosclerosis (AS) is an important cause of morbidity and mortality in cardiovascular diseases such as coronary atherosclerotic heart disease and stroke. As the primary natural barrier between blood and the vessel wall, damage to vascular endothelial cells (VECs) is one of the initiating factors for the development of AS. VECs primarily use aerobic glycolysis for energy supply, but several diseases can cause altered glucose metabolism in VECs. Glucose metabolism reprogramming of VECs is the core event of AS, which is closely related to the development of AS. In this review, we review how glucose metabolism reprogramming of VECs promotes the development of AS by inducing VEC barrier dysfunction, autophagy, altering the inflammatory response, and proliferation of VECs, in the hopes of providing new ideas and discovering new targets for the prevention and treatment of AS.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"423"},"PeriodicalIF":1.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patent Foramen Ovale (PFO): History, Diagnosis, and Management.","authors":"Aurel Maloku, Ali Hamadanchi, Albrecht Günther, Pawel Aftanski, P Christian Schulze, Sven Möbius-Winkler","doi":"10.31083/j.rcm2511422","DOIUrl":"https://doi.org/10.31083/j.rcm2511422","url":null,"abstract":"<p><p>Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. Other trials, such as the REDUCE trial, presented much better data with a NNT of 28 at two years and as low as 18 over a follow-up period of 10 years. Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. Usually, a double-disk occlusion device is used, followed by antiplatelet therapy. While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"422"},"PeriodicalIF":1.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technique and Preliminary Results of Sole-echocardiography-guided Tricuspid Transcatheter Edge-to-edge Repair without the Use of Fluoroscopy.","authors":"Manchen Gao, Hao Shi, Cheng Wang, Hong Meng, Jiande Wang, Da Zhu, Zhiling Luo, Chuangshi Wang, Ziping Li, Junke Chang, Fengwen Zhang, Xiangbin Pan, Shouzheng Wang","doi":"10.31083/j.rcm2511413","DOIUrl":"https://doi.org/10.31083/j.rcm2511413","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as an attractive option for severe tricuspid regurgitation (TR). To avoid the radiation exposure for both patients and medical staff, we propose a sole-echocardiography-guided method for T-TEER. The purpose of this article was to investigate the feasibility of sole-echocardiography-guided T-TEER.</p><p><strong>Methods: </strong>This was a retrospective observational study, including 43 patients who underwent sole-echocardiography-guided T-TEER at two medical centers in China between June 2022 and September 2023. Clinical and echocardiographic data were collected at baseline, discharge and 6-month follow-up.</p><p><strong>Results: </strong>Patients enrolled in this study were elderly (71.6 ± 8.2 years) with significant comorbidities, 67.4% had baseline massive or torrential TR and 76.7% were classified as New York Heart Association (NYHA) functional class III/IV. All patients achieved successful device implantation, and no severe device-related complications or mortality occurred during the follow-up period. Significantly reduced TR and reversed right ventricular remodeling were observed at 6-month follow-ups. Patients classified as NYHA functional class I/II increased from 23.3% at baseline to 81.4% at 6-month follow-up (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Sole-echocardiography-guided T-TEER has a low incidence of complications and can effectively reduce TR. It is feasible to substitute conventional fluoroscopy and echocardiography guidance for echocardiography guidance alone. Further large-scale randomized controlled trials are needed to validate the safety, efficacy and patient benefits of this technique.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"413"},"PeriodicalIF":1.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STEMI Antithrombotic Therapy: The Evolving Role of P2Y12 Inhibitor Pretreatment in Contemporary Practice.","authors":"Antonella Tommasino, Vincenzo Fiorentini, Giulia Mattaroccia, Alessandra Scoccia, Emanuele Barbato","doi":"10.31083/j.rcm2511416","DOIUrl":"https://doi.org/10.31083/j.rcm2511416","url":null,"abstract":"<p><p>The P2Y12 receptor plays a central role in platelet activation, secretion, and procoagulant activity. The CURE (clopidogrel in unstable angina to prevent recurrent events) trial, conducted in 2001, was the first to effectively demonstrate the benefit of dual anti-aggregation therapy with aspirin and clopidogrel in patients with acute coronary syndromes (ACS) undergoing invasive treatment. Since then, the field of interventional cardiology has changed considerably. The introduction of drug-eluting stents (DES) and the development of new, potent P2Y12 inhibitors such as ticagrelor, prasugrel and cangrelor have revolutionized the treatment of ACS. Nevertheless, ST-elevation myocardial infarction (STEMI) remains a critical condition that requires rapid and effective intervention. The use of P2Y12 receptor antagonists as part of the pretreatment strategy is an interesting topic to optimize outcomes in STEMI patients. This review summarizes the existing evidence on the efficacy and safety of pretreatment with P2Y12 receptor antagonists in STEMI, and emphasizes the importance of making pretreatment decisions based on individual clinical characteristics. The review also looks to the future, pointing to the potential role of artificial intelligence (AI) in improving STEMI diagnosis and treatment decisions, suggesting a future where technology could improve the accuracy and timeliness of care for STEMI patients.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"416"},"PeriodicalIF":1.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Cardiac Macrophages in Inflammation and Fibrosis after Myocardial Ischemia-Reperfusion.","authors":"Kaiqin Jin, Zijun Ma, Xiaohe Wang, Chen Gong, Jianlong Sheng, Jun Chen, Shichun Shen","doi":"10.31083/j.rcm2511419","DOIUrl":"https://doi.org/10.31083/j.rcm2511419","url":null,"abstract":"<p><p>According to current statistics, the mortality rate of cardiovascular diseases remains high, with coronary artery disease being the primary cause of death. Despite the widespread adoption of percutaneous coronary intervention (PCI) in recent years, which has led to a notable decrease in the mortality rate of myocardial infarction (MI), the pathological cardiac remodeling and heart failure that follow myocardial infarction still pose significant clinical challenges. Myocardial ischemia-reperfusion (MIR) injury represents a complex pathophysiological process, and the involvement of macrophages in this injury has consistently been a subject of significant focus. Following MIR, macrophages infiltrate, engulfing tissue debris and necrotic cells, and secreting pro-inflammatory factors. This initial response is crucial for clearing damaged tissue. Subsequently, the pro-inflammatory macrophages (M1) transition to an anti-inflammatory phenotype (M2), a shift that is essential for myocardial fibrosis and cardiac remodeling. This process is dynamic, complex, and continuous. To enhance understanding of this process, this review elaborates on the classification and functions of macrophages within the heart, covering recent research on signaling pathways involved in myocardial infarction through subsequent MIR injury and fibrosis. The ultimate aim is to reduce MIR injury, foster a conducive environment for cardiac recovery, and improve clinical outcomes for MI patients.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"419"},"PeriodicalIF":1.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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.","authors":"Aobo Gong, Wentao Li, Fanghui Li, Yao Tong, Ying Cao, Rui Zeng","doi":"10.31083/j.rcm2511415","DOIUrl":"https://doi.org/10.31083/j.rcm2511415","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>The prospero registration: </strong>CRD42023473026, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 11","pages":"415"},"PeriodicalIF":1.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}