Aims
To evaluate the efficacy of oesophageal cooling in the prevention of oesophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation.
Methods and results
Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of oesophageal cooling compared with control in the prevention of oesophageal injury during AF catheter ablation. The study primary outcome was the incidence of any oesophageal injury. The meta-analysis included 4 RCTs with a total of 294 patients. There was no difference in the incidence of any oesophageal injury between oesophageal cooling and control [15% vs. 19%; relative risk (RR) 0.86; 95% confidence interval (CI) 0.31–2.41]. Compared with control, oesophageal cooling showed lower risk of severe oesophageal injury (1.5% vs. 9%; RR 0.21; 95% CI 0.05–0.80). There were no significant differences among the two groups in mild to moderate oesophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28–4.23), procedure duration [standardized mean difference (SMD) −0.03; 95% CI −0.36–0.30], posterior wall radiofrequency (RF) time (SMD 0.27; 95% CI −0.04–0.58), total RF time (SMD −0.50; 95% CI −1.15–0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02–36.34), and ablation index (SMD 0.16; 95% CI −0.33–0.66).
Conclusion
Among patients undergoing AF catheter ablation, oesophageal cooling did not reduce the overall risk of any oesophageal injury compared with control. Oesophageal cooling might shift the severity of oesophageal injuries to less severe injuries. Further studies should evaluate the long-term effects after oesophageal cooling during AF catheter ablation.
BackgroundThere is a paucity of data regarding the comparative efficacy and safety of Mitral valve transcatheter edge‐to‐edge repair (MTEER) using the PASCAL or MitraClip systems for patients with mitral regurgitation (MR).MethodsAn electronic search was conducted for MEDLINE, COCHRANE, and EMBASE, through February 2023, for studies comparing the clinical outcomes of MTEER using PASCAL versus MitraClip systems among patients with severe MR. The primary study outcome was residual MR ≤ 2 at discharge. Data were pooled using a random‐effects model.ResultsThe final analysis included six studies with a total of 1581 patients, with a weighted follow‐up period of 3.5 months. Two studies only included patients with degenerative MR, while the remaining studies included both degenerative and functional MR. There was no significant difference in procedure duration between MTEER with the PASCAL or MitraClip systems. There was no difference in residual MR ≤ 2 at discharge (94.7% vs. 91.9%; odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.92–2.27) or residual MR ≤ 2 at the mid‐term follow‐up (94.6% vs. 91.0%, p = 0.05) among the PASCAL versus MitraClip systems. There was no difference between both groups in residual MR ≤ 1 at discharge (73.1% vs. 63.8%, p = 0.12), while there was greater incidence of residual MR ≤ 1 at midterm follow‐up with the PASCAL system (71.3% vs. 56.2%, p < 0.001). There was no difference between the PASCAL and MitraClip MTEER systems in technical success (97.0% vs. 97.9%, p = 0.15), procedural success (89.1% vs. 87.1%, p = 0.78), single leaflet detachment (1.8% vs. 1.4%, p = 0.55), or all‐cause mortality (3.6% vs. 4.6%, p = 0.71).ConclusionIn this meta‐analysis, we demonstrated comparable efficacy and safety between the PASCAL and MitraClip MTEER systems at short‐ and mid‐term assessments. Randomized trials are warranted to evaluate the comparative long‐term outcomes between both MTEER systems.
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