三维电子解剖图引导的零或近零透视导管消融治疗小儿心律失常的安全性和可行性：元分析

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Arrhythmia Pub Date : 2024-05-16 DOI:10.1002/joa3.13062

Gusti Ngurah Prana Jagannatha, I. Made Putra Swi Antara, Anastasya Maria Kosasih, Jonathan Adrian, Brian Mendel, Nikita Pratama Toding Labi, Wingga Chrisna Aji, Bryan Gervais de Liyis, Made Refika Widya Apsari Tangkas, Yosep Made Pius Cardia, Alif Hakim Alamsyah

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摘要

众所周知，在儿科人群中使用透视导管消融术会导致不良事件。本研究旨在评估零透视（ZF）和近零透视引导导管消融治疗儿科心律失常的有效性和安全性。研究人员检索并审查了 PubMed、Embase 和 Cochrane 图书馆数据库中的相关研究。关注的结果包括安全性、短期和长期有效性。我们将年龄小于21岁、接受ZF或近ZF消融术且透视时间小于1.5分钟的患者列为研究组，将同一年龄范围内接受常规透视和/或近ZF消融术且平均透视时间大于1.5分钟的患者列为对照组。ZF和近ZF消融术均采用三维电子解剖图（3D-EAM）。近ZF组的总透视时间（MD -15.93分钟，95% CI (-22.57 - (-9.29)，p < .001；I2 = 84%）和总手术时间（MD -22.06分钟，95% CI (-44.39 - (-0.28)，p < .001；I2 = 88%）显著低于ZF组。与传统透视相比，中频和近中频的成功率都有提高的趋势，但在所有亚组分析中均未达到统计学意义。与对照组相比，研究组的消融术还降低了并发症的发生率（RR 0.35；95% CI (0.14-0.90)；P = .03；I2 = 0%）。

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Safety and feasibility of 3D-electroanatomical mapping-guided zero or near-zero fluoroscopy catheter ablation for pediatric arrhythmias: Meta-analysis

Background

Catheter ablation in the pediatric population using fluoroscopy has been known to cause adverse events. This study aims to assess the effectiveness and safety of zero fluoroscopy (ZF) and near-ZF-guided catheter ablation for the treatment of arrhythmias in the pediatric population.

Methods

The PubMed, Embase, and Cochrane library databases were searched and reviewed for relevant studies. Outcomes of interest include safety, short-term, and long-term effectiveness. We classified patients ≤21 years old who underwent ZF or near-ZF ablation with fluoroscopy time ≤1.5 min as our study group and patients within the same age range who underwent conventional fluoroscopy and/or near-ZF ablation with a mean fluoroscopy time >1.5 min as our control group. Both ZF and near-ZF ablation utilized 3D-electroanatomical mapping (3D-EAM).

Results

Ten studies composed of 2279 patients were included in this study. Total fluoroscopy time (MD –15.93 min, 95% CI (−22.57 – (−9.29), p < .001; I² = 84%)) and total procedural time (MD –22.06 min, 95% CI (−44.39 – (−0.28), p < .001; I² = 88%)) were significantly lower in the near-ZF group. Both ZF and near-ZF demonstrated a trend towards improved success rates compared to conventional fluoroscopy but did not achieve statistical significance for all subgroup analyses. Ablation in the study group also decreased incidence of complication compared to the control (RR 0.35; 95% CI (0.14–0.90); p = .03; I² = 0%).