脉冲场消融vs高功率短时间/非常高功率短时间肺静脉隔离-系统评价和Kaplan-Meier重建个体患者数据的荟萃分析

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-09-01 DOI:10.1016/j.hroo.2025.06.011

Raymond Pranata MD , William Kamarullah MD , Giky Karwiky MD , Chaerul Achmad MD, PhD , Mohammad Iqbal MD, PhD, FHRS , Jae-Sun Uhm MD, PhD

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引用次数: 0

摘要

背景：高功率/非常高功率短时间（HPSD/VHPSD）肺静脉隔离比常规肺静脉隔离更有效，而脉冲场消融（PFA）的手术时间明显更短，但疗效相当。目的：本荟萃分析比较PFA与HPSD/VHPSD消融的疗效、手术时间和安全性。方法将心房颤动、扑动或心动过速复发定义为在3个月的空白期后，通过霍尔特监测或心电图检测到的任何持续30秒的房颤、扑动或心动过速复发。干预组采用PFA，对照组采用HPSD/VHPSD消融。结果共纳入8项研究（多为回顾性观察性研究），共纳入1411例患者。PFA组的ATa复发率低于HPSD/VHPSD消融组（PFA组为15%，HPSD/VHPSD消融组为25%；优势比0.57；95%可信区间[CI] 0.40-0.81; P = 0.002; I2 = 31.4%, P = 0.374）。meta回归分析显示，PFA的获益不受阵发性心房颤动、性别、年龄、高血压或左室射血分数的显著影响。重建的Kaplan-Meier曲线显示PFA组更容易出现ATa复发，随后重建的个体患者数据Cox回归分析显示风险比更低（风险比0.68;95% CI 0.48-0.97; P = 0.033）。肺静脉重连率具有可比性（PFA组32% vs HPSD/VHPSD消融组35%；优势比0.84;95% CI 0.53-1.34; P = 0.473）。PFA显著减少了总手术时间（平均差值-29.67分钟；95% CI -38.31至-21.03分钟；P < .001）。两组并发症发生率相似。结论与HPSD/VHPSD消融术相比，pfa可能与相当或更低的ATa复发率和更短的手术时间相关，同时保持相似的并发症发生率。需要进一步的随机对照试验来验证这些发现。普洛斯彼罗注册号crd420251034443。

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Pulsed field ablation vs high-power short duration/very high-power short duration pulmonary vein isolation—Systematic review and meta-analysis with Kaplan-Meier reconstructed individual patient data

Background

High-power/very high-power short-duration (HPSD/VHPSD) pulmonary vein isolation has greater efficacy than does conventional pulmonary vein isolation, while pulsed field ablation (PFA) is associated with a significantly shorter procedural duration with comparable efficacy.

Objective

This meta-analysis compared the efficacy, procedural duration, and safety of PFA vs HPSD/VHPSD ablation.

Methods

Atrial tachyarrhythmia (ATa) recurrence was defined as any episode of atrial fibrillation, flutter, or tachycardia lasting >30 seconds, detected by Holter monitoring or electrocardiography, after a 3-month blanking period. The intervention group received PFA and the control group received HPSD/VHPSD ablation.

Results

Eight studies (mostly retrospective observational) comprising 1411 patients were analyzed. ATa recurrence occurred less frequently in the PFA group than in the HPSD/VHPSD ablation group (15% in PFA vs 25% in HPSD/VHPSD ablation; odds ratio 0.57; 95% confidence interval [CI] 0.40–0.81; P = .002; I² = 31.4%, P = .374). Meta-regression analysis indicated that the benefit of PFA was not significantly influenced by paroxysmal atrial fibrillation, sex, age, hypertension, or left ventricular ejection fraction. Reconstructed Kaplan-Meier curves showed greater freedom from ATa recurrence in the PFA group, and subsequent reconstructed individual patient data Cox regression analysis showed a lower hazard ratio (hazard ratio 0.68; 95% CI 0.48–0.97; P = .033). Pulmonary vein reconnection rates were comparable (32% in PFA vs 35% in HPSD/VHPSD ablation; odds ratio 0.84; 95% CI 0.53–1.34; P = .473). PFA significantly reduced total procedural duration (mean difference –29.67 minutes; 95% CI –38.31 to –21.03 minutes; P < .001). Complications rates were similar between the 2 groups.

Conclusion

PFA was potentially associated with a comparable or reduced ATa recurrence rate and a shorter procedural duration compared with HPSD/VHPSD ablation while maintaining similar complication rates. Further randomized controlled trials are warranted to validate these findings.