对比冷冻消融和射频消融治疗房室结折返性心动过速的荟萃分析

Comparison Between Cryoablation and Radiofrequency Catheter Ablation for Treating the Patients With Atrio-ventricular Nodal Reentrant Tachycardia by Meta-analysis

目的:本研究旨在对比冷冻消融和射频消融治疗房室结折返性心动过速(AVNRT)的有效性和安全性。方法:对Medline、The Cochrane Library、Embase数据库进行系统性检索,检索截止时间为2014-05,纳入满足选择标准的研究。结果:最终5篇随机对照研究和14篇回顾性研究入选。研究总人群2 900例,其中1 384例分布在冷冻组,1 516例分布在射频组。总体结果显示,与射频消融相比,尽管冷冻消融减少永久性房室传导阻滞(AVB)的风险(OR:0.27;95%CI 0.11~0.62,P<0.01)和X线透视时间(WMD:-3.36;95%CI-5.58^-1.15,P<0.01),但冷冻消融的即刻成功率略低(OR:0.63;95%CI 0.42~0.96,P<0.05),花费更长的手术时间(WMD:10.97;95%CI 3.35~18.58,P<0.01),而且复发率明显更高(OR:2.89;95%CI 2.05~4.06,P<0.01)。结论:虽然冷冻消融治疗AVNRT减少房室阻滞的风险,但有效性低于射频消融。

Objective： The compare the safety and efficacy between cryoablation（CRYO） and radiofrequency catheter ablation（RFCA） for treating the patients with atrio-ventricular nodal reentrant tachycardia（AVNRT） by meta-analysis.Methods： We systemically searched the Medline, Cochrane library and Embase database to fulfill our pre-defined criteria until the publication of May 2014.Results： There were 5 randomized controlled trials（RCTs） and 14 retrospective trials enrolled in our study with 2900 patients. The patients were allocated into 2 groups： CRYO group, n=1384 and RFCA group, n=1516. The overall pool-analysis demonstrated that compared with RFCA group, CRYO group had the lower risk of permanent atrio-ventricular nodal block（OR： 0.27, 95% CI 0.11 to 0.62, P0.01） and shorter X-ray exposure time（WMD：-3.36, 95% CI-5.58 to-1.15, P0.01）; while CRYO group had the lower immediate procedural success rate（OR： 0.63, 95% CI 0.42 to 0.96, P0.05）, longer procedural time（WMD： 10.97, 95% CI 3.35 to 18.58, P 0.01）, and higher long-term arrhythmia recurrence rate（OR： 2.89, 95% CI 2.05 to 4.06, P0.01）.Conclusion： Although CRYO could decrease the risk of permanent atrio-ventricular nodal block, while its effectiveness was lower than RFCA for AVNRT treatment in relevant patients.