Tipo:	Trabalho de Conclusão de Curso
Título:	Pulsed-field ablation versus thermal ablation for atrial fibrillation: A meta-analysis
Autor(es):	Daher, Rafael Ferreira
Primeiro Orientador:	Menezes Junior, Antônio da Silva
metadata.dc.contributor.referee1:	Silva, Antonio Márcio Teodoro Cordeiro
Resumo:	BACKGROUND Pulsed-fieldablation(PFA)isanalternative tothermal ablation (TA) in patients with atrial fibrillation (AF) receiving catheter-based therapy for pulmonary vein isolation (PVI). However, its efficacy and safety have yet to be fully elucidated. OBJECTIVE Thepurposeofthisstudywastocomparetheacuteand long-term efficacies and safety of PFA and TA. METHODS We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials comparing PFA and TA in patients with AF undergoing their first PVI ablation. The TA group was divided into cryoballoon (CB) and radiofrequency subgroups. AF patients were divided into paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF) subgroups for further analysis. RESULTS Eighteen studies involving 4998 patients (35.2% PFA) were included. Overall, PFA was associated with a shorter procedure time (mean difference [MD]–21.68; 95% confidence interval [CI]–32.81 to–10.54) but longer fluoroscopy time (MD 4.53; 95% CI 2.18–6.88) than TA. Regarding safety, lower (peri-)esophageal injury rates (odds ratio [OR] 0.17; 95% CI 0.06–0.46) and higher tamponade rates (OR 2.98; 95% CI 1.27–7.00) were observed after PFA. In efficacy assessment, PFA was associated with a better firstpass isolation rate (OR 6.82; 95% CI 1.37–34.01) and a lower treatment failure rate (OR 0.83; 95% CI 0.70–0.98). Subgroup analysis showed no differences in PersAF and PAF. CB was related to higher (peri)esophageal injury, and lower PVI acute success and procedural time. CONCLUSION Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates in procedural data.
Palavras-chave:	Cryoballoon ablation; Paroxysmal atrial fibrillation; Persistent atrial fibrillation; Pulmonary vein isolation; Pulsed-field ablation; Radiofrequency ablation; Thermal ablation
CNPq:	CNPQ::CIENCIAS DA SAUDE CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA
Idioma:	eng
País:	Brasil
Editor:	Pontifícia Universidade Católica de Goiás
Sigla da Instituição:	PUC Goiás
metadata.dc.publisher.department:	Escola de Ciências Médicas e da Vida
Tipo de Acesso:	Acesso Aberto
URI:	https://repositorio.pucgoias.edu.br/jspui/handle/123456789/8849
Data do documento:	27-Out-2024
Aparece nas coleções:	TCC Medicina

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