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Pulsed-field ablation versus thermal ablation for atrial fibrillation: A meta-analysis.
de Campos, Maria Clara Azzi Vaz; Moraes, Vitor Ryuiti Yamamoto; Daher, Rafael Ferreira; Micheleto, José Pedro Cassemiro; de Campos, Luiza Azzi Vaz; Barros, Guilherme Fleury Alves; de Oliveira, Heitor Martins; Barros, Lorrany Pereira; Menezes, Antonio da Silva.
Afiliação
  • de Campos MCAV; Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
  • Moraes VRY; Clinical Medicine Department, Medical School, Evangelical University of Goiás, Anápolis, Goiás, Brazil.
  • Daher RF; Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
  • Micheleto JPC; Clinical Medicine Department, Medicine Faculty, Federal University of Alagoas, Maceió, Alagoas, Brazil.
  • de Campos LAV; Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
  • Barros GFA; Internal Medicine Department, Medical Faculty, Federal University of Goiás, Goiânia, Goiás, Brazil.
  • de Oliveira HM; Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
  • Barros LP; Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
  • Menezes ADS; Internal Medicine, Medical Sciences and Life School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
Heart Rhythm O2 ; 5(6): 385-395, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38984363
ABSTRACT

Background:

Pulsed-field ablation (PFA) is an alternative to thermal ablation (TA) in patients with atrial fibrillation (AF) receiving catheter-based therapy for pulmonary vein isolation (PVI). However, its efficacy and safety have yet to be fully elucidated.

Objective:

The purpose of this study was to compare the acute and long-term efficacies and safety of PFA and TA.

Methods:

We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials comparing PFA and TA in patients with AF undergoing their first PVI ablation. The TA group was divided into cryoballoon (CB) and radiofrequency subgroups. AF patients were divided into paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF) subgroups for further analysis.

Results:

Eighteen studies involving 4998 patients (35.2% PFA) were included. Overall, PFA was associated with a shorter procedure time (mean difference [MD] -21.68; 95% confidence interval [CI] -32.81 to -10.54) but longer fluoroscopy time (MD 4.53; 95% CI 2.18-6.88) than TA. Regarding safety, lower (peri-)esophageal injury rates (odds ratio [OR] 0.17; 95% CI 0.06-0.46) and higher tamponade rates (OR 2.98; 95% CI 1.27-7.00) were observed after PFA. In efficacy assessment, PFA was associated with a better first-pass isolation rate (OR 6.82; 95% CI 1.37-34.01) and a lower treatment failure rate (OR 0.83; 95% CI 0.70-0.98). Subgroup analysis showed no differences in PersAF and PAF. CB was related to higher (peri)esophageal injury, and lower PVI acute success and procedural time.

Conclusion:

Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates in procedural data.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Heart Rhythm O2 Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Heart Rhythm O2 Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos