Akerström Finn, Bastani Hamid, Insulander Per, Schwieler Jonas, Arias Miguel A, Jensen-Urstad Mats
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
J Cardiovasc Electrophysiol. 2014 Sep;25(9):948-952. doi: 10.1111/jce.12423. Epub 2014 May 2.
Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation (PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.
To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).
All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA-AT) based on invasive mapping procedure findings and ECG P-wave morphology.
The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow-up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA-AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow-up was 3.5%.
In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.
消融术后房性心动过速（AT）是射频（RF）肺静脉隔离（PVI）后的一种重要并发症。冷冻球囊（CB）消融是PVI的一种替代技术，其AT发生率似乎较低。尚未对RF消融和CB消融的AT风险进行直接比较。
比较阵发性心房颤动（AF）患者接受RF和CB消融进行PVI后AT的发生率和特征。
纳入2006年1月至2012年9月期间首次使用RF或CB消融进行PVI的所有患者。当针对AT进行重复消融手术时，根据侵入性标测程序结果和心电图P波形态，将心律失常分类为典型的三尖瓣峡部（CTI）扑动或左房性心动过速（LA-AT）。
研究人群分别包括RF组和CB组的415例和215例连续患者。平均随访38±21个月后，52例（8.3%）患者出现AT（RF组和CB组分别为9.4%和6%；P = 0.15）。其中，26例（4.1%）被分类为LA-AT，RF组20例（4.8%），CB组6例（2.8%）（P = 0.23）。在没有典型CTI扑动或CTI线病史的患者（n = 458）中，随访期间这种类型心律失常的发生率为3.5%。
对于接受RF或CB PVI作为唯一消融策略的阵发性AF患者，术后AT的发生率较低，两种技术之间无显著差异。
