Efficacy and Safety of Pulsed Field Ablation in Atrial Fibrillation: A Systematic Review

被引：14

作者：

Shtembari, Jurgen ^{[1
]}

Shrestha, Dhan Bahadur ^{[1
]}

Pathak, Bishnu Deep ^{[2
]}

Dhakal, Bishal ^{[3
]}

Regmi, Binit Upadhaya ^{[2
]}

Patel, Nimesh K. K. ^{[4
]}

Shantha, Ghanshyam Palamaner Subash ^{[5
]}

Kalahasty, Gautham ^{[6
]}

Kaszala, Karoly ^{[6
]}

Koneru, Jayanthi N. N. ^{[6
]}

机构：

[1] Mt Sinai Hosp, Dept Internal Med, Chicago, IL 60608 USA

[2] Jibjibe Primary Hlth Care Ctr, Dept Internal Med, Jibjibe 45000, Nepal

[3] Nepalese Army Inst Hlth Sci, Dept Internal Med, Kathmandu 44600, Nepal

[4] Virginia Commonwealth Univ, Sch Med, Dept Internal Med, Div Cardiol, Richmond, VA 23219 USA

[5] Wake Forest Baptist Hlth, Dept Internal Med, Div Electrophysiol, Atrium Hlth, Med Ctr Blvd, Winston Salem, NC 27157 USA

[6] Virginia Commonwealth Univ, Sch Med, Dept Internal Med, Div Electrophysiol, Richmond, VA 23219 USA

来源：

JOURNAL OF CLINICAL MEDICINE | 2023年 / 12卷 / 02期

关键词：

atrial fibrillation; pulmonary vein isolation; catheter ablation; pulse-field ablation; PULMONARY VEIN ISOLATION; OUTCOMES;

D O I：

10.3390/jcm12020719

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with high morbidity and mortality. AF treatment is guided by a patient-provider risk-benefit discussion regarding drug versus ablation or combination. Thermal ablation has a high rate of adverse events compared to pulsed field ablation (PFA). In this systematic review, we aimed to determine the safety and efficacy of PFA. Methods: The electronic search for relevant articles in English was completed in PubMed, PubMed Central, Cochrane library, Scopus, and Embase databases till July 2022. The screening was completed via the use of Covidence software. The risk of bias assessment and data extraction from the included studies was performed, and the narrative synthesis was performed accordingly. Results: A total of six studies were selected for review and 1897 patients receiving PFA were involved in these studies. Our review was focused on pulmonary vein isolation success, major adverse events, and arrhythmia recurrence. Successful pulmonary vein isolation (PVI) was completed in 100% of cases except in two studies. In one of them, six out of seven patients (86%) in the epicardial cohort had successful PVI. In the MANIFEST-PF survey, the acute PVI success rate was 99.9%. The major complications were rare and included pericardial tamponade, vascular complications requiring surgery, and stroke. The atrial arrhythmia recurrence was higher in the thermal group than in the PFA group (39% vs. 11%). Conclusions: The success rate of PVI by PFA is high, and major adverse events are low. PFA is found to decrease the recurrence of atrial arrhythmia compared to thermal ablation. Substantial randomized controlled trials (RCTs) are needed to validate the efficacy and safety of PFA over conventional methods.

引用

页数：11