Dados do Trabalho

Título

The comparative efficacy of cryoballoon ablation and pulsed-field ablation for atrial fibrillation: an updated systematic review and meta-analysis

Resumo

Introduction: Among the thermal methods for treating atrial fibrillation (AF) is cryoballoon ablation (CBA), which has a minimal risk of complications because of lesions caused by cryoenergy. However, a non-thermal option that shows promise for further reduction in complications is pulsed-field ablation (PFA).
Purpose: We aim to conduct an updated systematic review and meta-analysis comparing the efficacy and safety of PFA versus CBA in patients with AF.
Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials or observational studies that compared PFA and CBA ablation techniques in patients with AF. Statistical analysis was carried out utilizing RevMan 5.1.7. Heterogeneity was assessed with I² statistics; p-values inferior to 0.05 and I²>25% were considered significant heterogeneity.
Results: In the initial search, 845 studies were screened, and 26 were selected for full-text review based on inclusion criteria. Out of these, 9 observational studies involving 3,517 patients were included. Among them, 1,302 (37.0%) underwent PFA, while 2,215 (63%) underwent CBA. Significant differences were noted between the two groups. Specifically, there was a notable reduction in procedure time in the PFA group (MD -9.95 min; 95% CI -14.86 to -5.04; p<0.0001; I²=95%; Fig.1A). Additionally, a statistically significant distinction was observed in terms of fluoroscopy time (MD 1.86 min; 95% CI 0.15 to 3.57; p=0.03; I²=92%; Fig. 1B) in the CBA group. However, there were no significant differences in periprocedural complications between patients who underwent PFA compared to those in the CBA group (RR 0.65; 95% CI 0.35 to 1.18; p=0.16; I²=43%; Fig. 2A). Additionally, no disparity was noted between the groups regarding the recurrence of atrial arrhythmias after the blanking period (RR 0.84; 95% CI 0.68 to 1.04; p=0.12; I²=6%; Fig. 2B).
Conclusion: In this systematic review and meta-analysis, PFA demonstrated a shorter procedure duration compared to CBA in patients with AF. Moreover, the fluoroscopy time favored the CBA group. However, PFA did not exhibit potential for reducing the recurrence of atrial arrhythmias and didn't show differences between the groups concerning periprocedural complications.

Palavras Chave

Ablação; Fibrilação atrial; Meta-análise

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