阵发性心房颤动病人使用冷冻球囊消融与射频导管消融治疗的安全性及长期有效性Meta分析  

The Safety and Long-term Effectiveness of Cryoballoon Ablation and Radiofrequency Catheter Ablation in Patients with Paroxysmal Atrial Fibrillation:a Meta-analysis

作　　者：史艳军 孙萌[1] 张楠[1] 焦丽琴 潘非非 李鹏[1] 王睿[1] SHI Yanjun;SUN Meng;ZHANG Nan;JIAO Liqin;PAN Feifei;LI Peng;WANG Rui(First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学第一医院,太原030001

出　　处：《中西医结合心脑血管病杂志》2020年第15期2387-2395,共9页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的评估阵发性心房颤动(PAF)病人使用冷冻球囊或射频导管消融治疗的安全性与长期有效性。方法系统检索PubMed、Cochrane图书馆数据库、EMbase、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(CBM)、中国学术期刊网络出版总库(CAJD)和中国科技期刊数据库(CSTJ)等数据库,检索时间自各库建库至2018年10月,包括系统评价和随机对照试验研究(RCT),且文献报道有使用冷冻球囊消融与射频导管消融治疗安全性、有效性、技术性能结果以及至少12个月的随访疗效情况。由3名研究员独立评估纳入研究资格及范围,对所有纳入的研究通过Cochrane协作网的偏倚风险工具评估方法学质量。结果最终纳入7项随机对照试验研究(RCT),共1529例病人。Meta分析显示:在单次消融术后12个月无复发性心房颤动[RR=1.06,95%CI(0.76,1.48),P=0.74]或房性快速性心律失常[RR=0.99,95%CI(0.91,1.08),P=0.89]方面,冷冻球囊组和射频组比较差异无统计学意义,在透视时间[MD=-3.14,95%CI(-10.38,4.11),P=0.40]、心包积液/填塞[RR=0.37,95%CI(0.11,1.26),P=0.11]方面,冷冻球囊组和射频组比较差异无统计学意义。冷冻球囊消融总手术时间缩短[MD=-12.57,95%CI(-23.35,-1.79),P<0.05],但膈神经麻痹(PNP)发生率较高[RR=10.49,95%CI(3.22,34.16),P<0.0001]。结论现有证据表明,在PAF病人中,冷冻球囊消融和射频消融在无复发性心房颤动或无复发性房性快速心律失常的长期有效性方面比较差异无统计学意义,但具有不同的安全性,冷冻球囊消融更可能引起膈神经麻痹。Objective To evaluate the safety and long-term effectiveness of cryoballoon ablation and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation.Methods PubMed,the Cochrane Library Database,EMbase,China Journal Full-Text Database(CNKI),Wanfang database,VIP Database(VIP),Chinese Biomedical Literature Database(CBM),Chinese Academic Journal Network Publication Total Database(CAJD),and Chinese Scientific Journal Database(CSTJ)were searched by computer before October 2018,including systematic reviews,randomized controlled trials,reporting safety,effectiveness,and technical performance results follow-up at least 12 months.Three investigators independently assessed the eligibility and inclusion of the included studies,and all of included studies,the methodological quality assessed by the Cochrane Collaboration's bias risk tool.Results Seven literatures were included,including 1529 patients.The results of Meta-analysis showed that after single ablation for 12 months,there was no significant difference in recurrent atrial fibrillation[RR=1.06,95%CI(0.76,1.48),P=0.74],atrial tachycardia[RR=0.99,95%CI(0.91,1.08),P=0.89],fluoroscopy time[MD=-3.14,95%CI(-10.38,4.11),P=0.40],and pericardial effusion/cardiac tamponade[RR=0.37,95%CI(0.11,1.26),P=0.11]between the cryoballoon group and the radiofrequency group.The total operative time of cryoballoon ablation was shortened[MD=-12.57,95%CI(-23.35,-1.79),P<0.05],and the incidence of phrenic nerve palsy was higher[RR=10.49,95%CI(3.22,34.16),P<0.0001].Conclusion Current evidence showed that there was no statistically significant difference in the long-term effectiveness of cryoballoon ablation and radiofrequency ablation in the absence of recurrent atrial fibrillation or recurrent atrial tachycardia,in paroxysmal atrial fibrillation patients,but cryoballoon ablation was more likely to cause phrenic nerve palsy.

关 键 词：阵发性心房颤动 冷冻球囊消融 射频消融 META分析 安全性 有效性 

分 类 号：R541.7[医药卫生—心血管疾病] R256.2[医药卫生—内科学]