消融指数指导下心房颤动高功率射频消融有效性和安全性的meta分析

Efficacy and safety of high power radiofrequency ablation guided by ablation index in atrial fibrillation ablation: a meta-analysis

目的:评价消融指数(ablation index, AI)指导下心房颤动(房颤)高功率射频消融的有效性和安全性。方法:检索PubMed、EMBASE、Cochrane Library、中国知网、万方数据库中自建库以来至2023年1月19日关于比较AI指导下高功率与常规功率房颤射频消融的文献。使用Revman 5.4、Stata 15.1进行统计学分析。结果:18篇文献,共3 206例患者被纳入本研究。与常规功率组比较,高功率组单圈隔离率高(RR=1.13,95%CI:1.06~1.21,P=0.000 3);房颤复发率低(RR=0.55,95%CI:0.43~0.71,P<0.000 01);急性肺静脉传导恢复率无显著差异(RR=0.77,95%CI:0.34~1.61,P=0.49);食管并发症发生率无显著差异(RR=1.06,95%CI:0.33~3.40,P=0.92);肺静脉隔离时间明显缩短(MD=-17.01,95%CI:-21.79~-12.23,P<0.000 01)。结论:AI指导下房颤高功率射频消融是安全、有效的。与常规功率消融相比,其单圈隔离率更高,复发率更低,手术时间更短,急性肺静脉传导恢复率和食管并发症发生率相当。

Objective To evaluate the efficacy and safety of ablation index(AI)-guided high power radiofrequency ablation in atrial fibrillation(AF).Methods The PubMed,EMBASE,Cochrane Library,CNKI,and Wanfang databases were searched for studies comparing high power with conventional power atrial fibrillation radiofrequency ablation guided by AI since the established until January 19,2023.Statistical analysis was performed using Revman 5.4 and Stata15.1.Results Eighteen papers with a total of 3206 patients were included in this study.The high power group showed higher first-pass PVI of PVs(RR=1.13,95%CI:1.06-1.21,P=0.0003)and lower recurrence of AF(RR=0.55,95%CI:0.43-0.71,P<0.00001).There were insignificant differences in acute pulmonary vein reconnection(RR=0.77,95%CI:0.34-1.61,P=0.49)and esophageal complications(RR=1.06,95%CI:0.33-3.40,P=0.92).The PVI time were significantly shorter(MD=-17.01,95%CI:-21.79—-12.23,P<0.00001)in high power group.Conclusion AI-guided high power radiofrequency ablation was safe and efficient for treating AF,it showed higher first-pass PVI of PVs,lower recurrence of AF,and shorter procedure times.The events of acute pulmonary vein reconnection and esophageal complications were similar between the two groups.