Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Heart Rhythm. 2010;7(2):184-90. doi: 10.1016/j.hrthm.2009.10.038. Epub 2009 Nov 10.
Pulmonary vein isolation using the cryoballoon technique (CB-PVI) has evolved into a simple and safe alternative for point-by-point radiofrequency ablation. Systematic analysis of conduction recovery occurring after CB-PVI and causing recurrent atrial fibrillation has not yet been performed.
The purpose of this study was to analyze conduction recovery after PVI using the single big (28-mm) cryoballoon technique.
Twenty-six patients with recurrent atrial tachyarrhythmia after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by antral irrigated radiofrequency ablation using electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into six equally distributed segments.
PV reconduction frequently occurred into multiple (>2) PVs (54% patients). Conduction gaps could be abolished by single point ablation in 63% (lateral) and 41% (septal) of patients or by incomplete circular lesions in the remaining patients. A significantly higher number of patients exhibited conduction recovery at inferior segments (85% lateral, 77% septal) compared with superior segments (42% lateral, 31% septal). Furthermore, the ridge between PV ostia and left atrial appendage (LAA) was highly associated with reconduction into lateral PVs (81% of patients). Retrospective analysis of the initial CB-PVI-procedure revealed lower freezing temperatures at superior than inferior PVs as well as sharp catheter angulations with loss of central cryoballoon alignment to reach inferior PVs.
Conduction recovery after CB-PVI occurs at a high incidence at inferior sites around ipsilateral PV ostia and the LAA-PV ridge. Modifications of the technique to ensure optimal balloon-tissue contact at predilection sites may improve long-term success rates.
使用冷冻球囊技术（CB-PVI）进行肺静脉隔离已成为一种简单且安全的替代逐点射频消融的方法。但尚未对 CB-PVI 后发生的、导致复发性心房颤动的传导恢复进行系统分析。
本研究旨在分析使用单一大（28mm）冷冻球囊技术进行 PVI 后的传导恢复情况。
26 例既往 CB-PVI 后复发房性快速性心律失常的患者接受了重复消融。使用电生理标测下的环肺静脉消融进行肺静脉（PV）再隔离。为了分析传导间隙的位置，将同侧左心房-肺静脉交界处分为六个均匀分布的节段。
PV 再传导经常发生在多个（>2 个）PV 中（54%的患者）。在 63%（外侧）和 41%（间隔）的患者中，单点消融可消除传导间隙，而在其余患者中，不完全的环形消融可消除传导间隙。与上节段相比，下节段（外侧 85%，间隔 77%）的患者出现传导恢复的比例明显更高。此外，PV 口与左心耳（LAA）之间的嵴与外侧 PV 再传导高度相关（81%的患者）。对初始 CB-PVI 操作的回顾性分析显示，上 PV 处的冷冻温度低于下 PV 处，且冷冻球囊导管角度较锐，导致球囊中心偏离，难以到达下 PV。
CB-PVI 后传导恢复的发生率较高，发生在下侧肺静脉口周围及 LAA-PV 嵴附近。为了改善长期成功率，可对技术进行改进，以确保在易发生的部位实现球囊与组织的最佳接触。
