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Journal of Cardiovascular... Sep 2021In May 2020, a novel cryoballoon system (POLARx; Boston Scientific) became available for catheter ablation of atrial fibrillation (AF). The design of the cryoballoon is... (Meta-Analysis)
Meta-Analysis
Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: A systematic review and meta-analysis.
INTRODUCTION
In May 2020, a novel cryoballoon system (POLARx; Boston Scientific) became available for catheter ablation of atrial fibrillation (AF). The design of the cryoballoon is comparable to the Arctic Front Advance Pro (AFA-Pro; Medtronic), but it is more compliant during freezing. We compared the procedural efficacy, biophysical parameters, and risk of phrenic nerve palsy (PNP) between the two cryoballoons.
METHODS
Embase, MEDLINE, Web of Science, Cochrane, and Google Scholar databases were searched until June 1, 2021 for relevant studies comparing POLARx versus AFA-Pro in patients undergoing pulmonary vein isolation (PVI) for AF.
RESULTS
A total of four studies, involving 310 patients were included. There was no difference between the two groups for outcomes regarding procedural efficacy: acute PVI (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.06 to 3.03; p = .40), procedure time (mean difference [MD]: 8.15 min; 95% CI: -8.09 to 24.39; p = .33), fluoroscopy time (MD: 1.32 min; 95% CI: -1.61 to 4.25; p = .38) and ablation time (MD: 1.00 min; 95% CI: -0.20 to 2.20; p = .10). The balloon nadir temperature was lower for all individual pulmonary veins (PV) in POLARx compared with AFA-Pro (MD: -9.74°C, -9.98°C, -6.72°C, -7.76°C, for left superior PV, left inferior PV, right superior PV, and right inferior PV, respectively; all p < .001). The incidence of PNP was similar between groups (OR: 0.79; 95% CI: 0.22 to 2.85; p = .72).
CONCLUSION
In AF patients undergoing PVI, POLARx and AFA-Pro had a similar procedural efficacy. Balloon nadir temperatures were lower with POLARx, however, the incidence of PNP was similar.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Incidence; Paralysis; Phrenic Nerve; Pulmonary Veins; Temperature; Treatment Outcome
PubMed: 34289198
DOI: 10.1111/jce.15182 -
Frontiers in Cardiovascular Medicine 2021Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs)....
Catheter Ablation vs. Anti-Arrhythmic Drugs as First-Line Treatment in Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Catheter ablation has become a well-established indication for long-term rhythm control in atrial fibrillation (AF) patients refractory to anti-arrhythmic drugs (AADs). Efficacy and safety of AF catheter ablation (AFCA) before AADs failure are, instead, questioned. The aim of the study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing first-line AFCA with AADs in symptomatic patients with paroxysmal AF. We performed a random-effects meta-analysis of binary outcome events comparing AFCA with AADs in rhythm control-naïve patients. The primary outcomes, also stratified by the type of ablation energy (radiofrequency or cryoenergy), were (1) recurrence of atrial tachyarrhythmias and (2) recurrence of symptomatic atrial tachyarrhythmias. The secondary outcomes included adverse events. Six RCTs were included in the analysis. AFCA was associated with lower recurrences of atrial tachyarrhythmias [relative risk (RR) 0.58, 95% confidence interval (CI) 0.46-0.72], consistent across the two types of ablation energy (radiofrequency, RR 0.50, 95% CI 0.28-0.89; cryoenergy, RR 0.60, 95% CI 0.50-0.72; -value for subgroup differences: 0.55). Similarly, AFCA was related to less symptomatic arrhythmic recurrences (RR 0.46, 95% CI 0.27-0.79). Overall, adverse events did not differ. A trend toward increased periprocedural cardiac tamponade or phrenic nerve palsy was observed in the AFCA group, while more atrial flutter episodes with 1:1 atrioventricular conduction and syncopal events were reported in the AAD group. First-line rhythm control therapy with AFCA, independent from the adopted energy source (radiofrequency or cryoenergy), reduces long-term arrhythmic recurrences in patients with symptomatic paroxysmal AF compared with AADs.
PubMed: 34095254
DOI: 10.3389/fcvm.2021.664647 -
Journal of Atrial Fibrillation 2020The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis...
BACKGROUND
The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis of the overall prevalence of right phrenic nerve injury (RPNI), its course and its association with the superior and inferior pulmonary veins.
METHODS
Through December 2017, a database search was performed on PubMed, Science Direct, EMBASE, SciELO, and Web of Science. The references were also extensively searched in the included articles.
RESULTS
Detection of the RPN may vary according to the identification method. It ranges from 100% in postmortem studies, 93% in intraoperative, to 57.88% in computer tomography (CT) imaging. Based on the included studies (n-507), the distance from the right superior pulmonary vein (RSPV) ostium to the RPN was 12.48mm (±6.21). In postmortem studies, the distance was 6.92mm (±3.94); in pre or intraoperative techniques, 13.32mm (±5.96) if noninvasive, 13.97mm (±7.8) if invasive. Distances ranged from 0DC342.6 mm. For the right inferior pulmonary vein (RIPV) (n-125) the mean distance was 16.53mm (±8.92) with distances from 0.4 68mm. The risk of RPNI with distance-included studies was 12.46% (47 RPNI in 377 cases). In the meta-analysis, the distance from the RSPV to the RPN that was associated with an increased risk of RPNI was 7.36mm.
CONCLUSIONS
RPNI is a relatively rare complication. A firm understanding of its course, relation to the PV ostium, and detection are vital for preventing future injuries and complications.
PubMed: 34950302
DOI: 10.4022/jafib.2305 -
Diagnostics (Basel, Switzerland) Nov 2019The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain... (Review)
Review
The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.
PubMed: 31726685
DOI: 10.3390/diagnostics9040186 -
Kardiologia Polska Jan 2020Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging.
AIM
This meta‑analysis aimed to compare cryoballoon ablation (CBA) with radiofrequency ablation (RFA) for persistent AF.
METHODS
A systematic search of the PubMed, EMBASE, and Cochrane Library databases was performed for studies comparing the outcomes between CBA and RFA. Seven trials including 934 patients were analyzed.
RESULTS
There were no differences between groups in terms of freedom from atrial arrhythmia (risk ratio [RR], 1.04; 95% CI, 0.93-1.15; P = 0.52; I2 = 0%), procedural complications (RR, 0.91; 95% CI, 0.52-1.59; P = 0.74; I2 = 0%), atrial fibrillation or atrial tachycardia relapse during the blanking period (RR, 0.73; 95% CI, 0.50-1.06; P = 0.1; I2 = 9%), repeat ablation (RR, 0.74; 95% CI, 0.45-1.21; P = 0.23; I2 = 62%), and vascular complications (RR, 0.98; 95% CI, 0.42-2.27; P = 0.97; I2 = 0%). Cryoballoon ablation increased the incidence of conversion to sinus rhythm during ablation (RR, 1.69; 95% CI, 1.01-2.83; P = 0.046; I2 = 0%) and phrenic nerve palsy (PNP; RR, 3.05; 95% CI, 0.95-9.8; P = 0.06; I2 = 0%), while RFA increased the risk of cardiac tamponade (RR, 0.27; 95% CI, 0.06-1.25; P = 0.09; I2 = 0%). Subanalyses revealed a lower incidence of recurrent atrial arrhythmia and repeat ablation during CBA without touch‑up RFA in pulmonary vein isolation.
CONCLUSIONS
CBA provides an alternative technique for persistent AF ablation. It might reduce the risk of repeat ablation and cardiac tamponade but increase the risk of PNP.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 31688837
DOI: 10.33963/KP.15048