基于多电极导管的脉冲电场与用于心房移除心房的冷却气球:系统性审查和元分析
Giampaolo Vetta1,2, Domenico Giovanni Della Rocca1,2,3, Antonio Parlavecchio4
1Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels 1090, Belgium.
概括
脉冲场切除 (PFA) 与冷凝气球切除 (CRYO) 相比,在心房动 (AF) 治疗中表现出更好的急性成功和安全性. 对于预防心房动脉节律失常 (ATs) 的长期有效性在PFA和CRYO之间仍然相似.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 电子生理学 电子生理学
背景情况:
- 脉冲场切除 (PFA) 是一种用于心房动 (AF) 治疗的新兴技术,以其组织特异性作用而闻名.
- 单次注射的pentaspline系统是第一个获得批准的PFA设备.
- 冰冷气球移除 (CRYO) 是目前AF治疗的标准护理技术.
研究的目的:
- 为了比较PFA的有效性和安全性,使用单次注射达斯林系统与第二/第三/第四代CRYO技术进行比较.
- 评估急性手术成功,并发症率,手术时间,以及长期无心房动脉节律失常 (ATS) 的情况.
主要方法:
- 进行了元分析,系统地在电子数据库中搜索相关研究.
- 包括的研究集中在使用PFA或CRYO技术的AF除.
- 主要终点包括急性手术成功 (静脉和患者基础) 和安全性 (整体和主要并发症). 二级终点是程序/光学时间和1年无ATS.
主要成果:
- 在静脉基础上 (99.9%与99.1%) 和每位患者 (99.5%与98.4%) 中,PFA显著更高的急性手术成功率.
- PFA与较低的整体周围手术并发症 (3.1%与5.6%) 和较短的手术 (75.9分钟与105.6分钟) 和光镜时间 (14.2分钟与18.9分钟) 相关.
- 在主要的周围手术并发症 (1.2%对1.0%) 或1年无AT (82.3%对80.3%) 中没有发现显著差异.
结论:
- 与CRYO相比,PFA提供了优越的急性手术成功和安全性,用于AF切除.
- 虽然PFA显示了急性结局的改善,但在预防AT复发的长期疗效与CRYO.相似.
- 这些发现支持PFA作为AF治疗的有希望的替代方案.
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