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.
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Abstract
Background: 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).
Methods: 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.
Results: 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).
Conclusions: 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.
The prospero registration: CRD42023473026, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026.
背景：本荟萃分析的目的是评估脉冲场消融（PFA）在房颤（AF）患者中的疗效和安全性，并将其与传统热消融的疗效和安全性进行比较。方法：检索PubMed、Web of Science和Embase，检索探讨PFA与传统热消融在af患者中的疗效和安全性的随机或观察性研究。结果：16项仅将PFA作为消融方法的研究共纳入4437例患者，9项将PFA与传统热消融进行比较的研究共纳入1792例患者。在单独考虑PFA的研究中，房性心律失常复发的自由度为0.80(95%可信区间[CI] 0.76-0.84)，围手术期并发症的发生率为0.03 （95% CI 0.02-0.05）。在比较研究中，与传统热消融相比，PFA在房性心律失常复发率（比值比（OR） 1.24, 95% CI 0.90-1.72）和围手术期并发症发生率（OR 0.74, 95% CI 0.37-1.48）方面无显著差异。在随访期小于12个月的亚组中，与热消融相比，PFA有更高的心房心律失常复发率（OR 2.19, 95% CI 1.14-4.20）。结论：PFA是一种安全有效的导管消融方法，不逊色于传统的热消融方法。它可以作为af患者的治疗选择。prospero注册号：CRD42023473026， https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026。
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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