脉冲场消融术治疗心房颤动时，在使用五线导管进行肺静脉隔离的同时进行左心房后壁隔离：系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2024-10-01 DOI:10.1016/j.hroo.2024.08.006

Raymond Pranata MD, William Kamarullah MD, Giky Karwiky MD, Chaerul Achmad MD, PhD, Mohammad Iqbal MD, PhD

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引用次数: 0

摘要

背景持续性心房颤动（房颤）可能需要广泛的消融策略。本荟萃分析旨在研究在脉冲场消融（PFA）治疗房颤时，除使用五线导管进行肺静脉隔离（PVI）外，使用左心房后壁隔离（LAPWI）的可行性和有效性。方法通过PubMed、SCOPUS、ScienceDirect和EuropePMC进行全面检索，以了解在房颤的PFA消融中使用五线导管进行LAPWI+PVI的研究报告。主要结果是房性心动过速（ATa）复发，定义为空白期后的房颤/房扑/房性心动过速。使用平均/中值 16 至 20 次的额外 PFA 应用，LAPWI 的成功率为 100%，无急性左房后壁重接和食管并发症的报道。在平均 240 ± 91 天的随访中，LAPWI+PVI 组的 ATa 复发率为 21% (95% CI 13%-29%; I2 = 84.8%)。元回归分析表明，年龄、左室射血分数和重复手术对 ATa 复发无明显影响（P > .05）。左心房直径每增加 1 毫米，ATa 复发几率增加 6%（R2 = 100%，P < .001，I2 = 0%）。Meta 分析表明，LAPWI+PVI 患者的 ATa 复发率与未进行 LAPWI 的患者相比没有差异（几率比 0.78，95% 置信区间 0.50-1.21，P = 0.27；I2 = 0%，P = 0.86）。手术时间和透视时间无明显差异（P >.05）。结论在 PFA 期间使用五针导管进行 LAPWI 是可行的，不会延长手术/透视时间，但不会减少 ATa 复发。在 PFA 期间可考虑进行 LAPWI，但其益处尚不确定。

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Left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation for atrial fibrillation: A systematic review and meta-analysis

Background

Persistent atrial fibrillation (AF) may require extensive ablation strategies. Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsed-field ablation (PFA).

Objective

This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF.

Methods

Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAPWI+PVI using a pentaspline catheter in PFA ablation for AF. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period.

Results

There were 882 patients from 7 studies. The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications. In mean follow-up of 240 ± 91 days, ATa recurrence was 21% (95% CI 13%–29%; I² = 84.8%) in the LAPWI+PVI group. Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (P > .05). Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R² = 100%, P < .001, I² = 0%). Meta-analysis showed no difference in terms of ATa recurrence among LAPWI+PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50–1.21, P = .27; I² = 0%, P = .86). Procedure time and fluoroscopy time did not significantly differ (P > .05).

Conclusion

LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence. LAPWI may be considered during PFA, although the benefit is uncertain.

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来源期刊

Heart Rhythm O2 Cardiology and Cardiovascular Medicine

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

52 days