II. Medizinische Abteilung, Asklepios Klinik St. Georg, Hamburg, Germany.
J Cardiovasc Electrophysiol. 2010 Dec;21(12):1427-31. doi: 10.1111/j.1540-8167.2010.01944.x. Epub 2010 Nov 23.
Pulmonary vein isolation using a cryoballoon has evolved into a relatively simple alternative for point-by-point radiofrequency ablation because this technology theoretically allows for PV isolation with a single application. Recent clinical studies indicate a high efficacy rate of the procedure; however, the incidence of the most common complication-phrenic nerve palsy (PNP)-has been reported in up to 11.2% of cases. Based on the present data, PNP is mainly associated with the use of the smaller 23 mm balloon. Very recently, it became evident that cryoballoon ablation may be associated with PV stenosis. Thus, the use of cryoballoon technology needs to be combined with a strategy aiming for maximal patient safety. The "single big (28 mm) cryoballoon technique" is a straightforward single-device strategy to deploy cryothermal lesions proximal to the PV ostium at the antrum level, thereby reducing the risk of collateral damage. Using this technique the endpoint of complete PV isolation was achieved in 97% of patients in our laboratory. PNP was observed in 4.4% of patients and resolved within 12 months in the majority of cases. In the future, development of an even bigger (32 mm) cryoballoon may further increase procedural safety by reducing the risk of PNP or PV stenosis.
使用冷冻球囊进行肺静脉隔离已发展成为一种相对简单的替代逐点射频消融的方法，因为这项技术理论上允许单次应用即可实现肺静脉隔离。最近的临床研究表明该手术具有较高的疗效，但最常见的并发症——膈神经麻痹（PNP）的发生率高达 11.2%。根据目前的数据，PNP 主要与使用较小的 23 毫米球囊有关。最近，冷冻球囊消融可能与肺静脉狭窄有关的事实变得明显。因此，需要结合旨在最大程度保障患者安全的策略来使用冷冻球囊技术。“单一大（28 毫米）冷冻球囊技术”是一种简单的单器械策略，可在肺静脉口近端的窦房水平部署冷冻损伤，从而降低了发生旁损伤的风险。在我们的实验室中，使用该技术 97%的患者达到了完全肺静脉隔离的终点。4.4%的患者出现了 PNP，且大多数情况下在 12 个月内得到缓解。未来，更大的（32 毫米）冷冻球囊的开发可能会通过降低 PNP 或肺静脉狭窄的风险进一步提高手术安全性。
