Elísio Bulhões, Roberto A S V Mazetto, Antunes L Vanio, Maria L R Defante, Luanna Feitoza, Camila Guida, Henry Huang
{"title":"脉冲场消融与高功率和高功率短时间射频消融治疗心房颤动的比较：系统回顾和荟萃分析。","authors":"Elísio Bulhões, Roberto A S V Mazetto, Antunes L Vanio, Maria L R Defante, Luanna Feitoza, Camila Guida, Henry Huang","doi":"10.1007/s10840-024-01970-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking.</p><p><strong>Objective: </strong>We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I<sup>2</sup> statistics.</p><p><strong>Results: </strong>Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I<sup>2</sup> = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I<sup>2</sup> = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I<sup>2</sup> = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I<sup>2</sup> = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I<sup>2</sup> = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I<sup>2</sup> = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I<sup>2</sup> = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm<sup>2</sup>; 95% CI -1269.44 to 3063.15; P = 0.42; I<sup>2</sup> = 39%).</p><p><strong>Conclusion: </strong>In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. Both techniques demonstrated comparable efficacy in treating atrial fibrillation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparing pulsed field ablation with very high-power and high-power short-duration radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.\",\"authors\":\"Elísio Bulhões, Roberto A S V Mazetto, Antunes L Vanio, Maria L R Defante, Luanna Feitoza, Camila Guida, Henry Huang\",\"doi\":\"10.1007/s10840-024-01970-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking.</p><p><strong>Objective: </strong>We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I<sup>2</sup> statistics.</p><p><strong>Results: </strong>Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I<sup>2</sup> = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I<sup>2</sup> = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I<sup>2</sup> = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I<sup>2</sup> = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I<sup>2</sup> = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I<sup>2</sup> = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I<sup>2</sup> = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm<sup>2</sup>; 95% CI -1269.44 to 3063.15; P = 0.42; I<sup>2</sup> = 39%).</p><p><strong>Conclusion: </strong>In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. 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引用次数: 0
摘要
背景：导管消融是房颤（AF）的关键治疗方法，其中大功率、甚大功率短时间脉冲场消融（PFA）是有效的选择。然而，这些技术之间缺乏直接的比较。目的：我们进行了一项系统回顾和荟萃分析，主要包括观察性研究（4项回顾性研究和1项前瞻性研究），比较PFA和高功率短时间（HPSD）和非常高功率短时间（vHPSD）射频（RF）消融在af患者中的应用。方法：我们检索PubMed， Embase和Cochrane Central。研究结果包括：无心律失常生存期（AF、心房扑动和房性心动过速复发，随访1个月后30秒）、手术时间、透视时间、透视剂量、总体并发症。采用R程序（4.3.2版）进行统计分析。采用I2统计量评估异质性。结果：我们的荟萃分析包括来自5项研究的1,255例患者，平均年龄从63岁到68岁不等。其中554例（45.2%）行脉冲场消融（PFA）， 701例（55.8%）行高/甚高电位短时间消融。PFA改善无心律失常生存率(RR 1.05；95% ci 1.002-1.120；p = 0.004；I2 = 0%)，缩短手术时间(MD -29.95 min；95% CI -30.90 ~ -29.00；p 2 = 0%)。然而，PFA增加透视时间(MD 6.33 min；95% CI 1.65 ~ 11.01；P 2 = 98%)，总并发症无显著差异(RR 0.88；95% ci 0.38-2.02；p = 0.756；I2 = 47%)、心包填塞(RR 1.62；95% ci 0.27-9.85；p = 0.599；I2 = 40%)，或卒中/短暂性脑缺血发作（TIA）发生率(RR 0.64；95% ci 0.15-2.80；p = 0.555；i2 = 0%)。PFA与减少重做过程的需求相关(RR 0.66；95% ci 0.45-0.97；p = 0.036；I2 = 0%)，对透视剂量无显著影响(MD 896.86 mGy·cm2；95% CI -1269.44至3063.15；p = 0.42；i2 = 39%)。结论：在这项荟萃分析中，PFA与改善无心律失常生存和缩短手术时间相关，尽管它导致透视时间增加。PFA和高/非常高功率短时间消融术在总体并发症、心脏填塞和卒中/TIA发生率方面的结果相似。两种技术在治疗房颤方面均表现出相当的疗效。
Comparing pulsed field ablation with very high-power and high-power short-duration radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.
Background: Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking.
Objective: We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF.
Methods: We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics.
Results: Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I2 = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I2 = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I2 = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I2 = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I2 = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I2 = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I2 = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm2; 95% CI -1269.44 to 3063.15; P = 0.42; I2 = 39%).
Conclusion: In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. Both techniques demonstrated comparable efficacy in treating atrial fibrillation.
期刊介绍：
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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