Wasserlauf Jeremiah, Pelchovitz Daniel J, Rhyner John, Verma Nishant, Bohn Martha, Li Zhi, Arora Rishi, Chicos Alexandru B, Goldberger Jeffrey J, Kim Susan S, Lin Albert C, Knight Bradley P, Passman Rod S
Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Pacing Clin Electrophysiol. 2015 Apr;38(4):483-9. doi: 10.1111/pace.12582. Epub 2015 Jan 28.
Catheter ablation is an established treatment for atrial fibrillation (AF). Cryoballoon ablation (CBA) has emerged as an alternative to radiofrequency ablation (RFA). However, there are few data comparing these modalities for treatment of paroxysmal AF (pAF) in the U.S.
The purpose of this study was to compare procedural times, safety, and efficacy of CBA against RFA.
A single-center prospective cohort study evaluated patients who underwent catheter ablation for pAF using CBA or RFA between January 1, 2010 and October 31, 2013. Patients with prior ablation and those without rhythm follow-up for at least 3 months were excluded. The primary end point was freedom from AF, atrial flutter, and atrial tachycardia (FFAF) >30 seconds after a 3-month blanking period without requirement for antiarrhythmic drugs. We also compared rates of successful pulmonary vein isolation (PVI), fluoroscopy and procedure times, and major complication rates.
A total of 201 patients were included (CBA = 101, RFA = 100). The rate of successful PVI was 99.3% in CBA versus 97.4% in RFA (P = 0.08). Procedure times were shorter with CBA (192.9 ± 44.0 minutes vs 283.7 ± 78.0 minutes, P < 0.001) as well as total fluoroscopy times (46.0 ± 22.4 minutes vs 73.0 ± 30.1 minutes, P < 0.001). Overall complication rates were equivalent; however, fewer cardiac perforations occurred with CBA (0% vs 4%, P = 0.042). The 1-year FFAF rates were 60.3% for CBA and 61.1% for RFA (log rank P = 0.93).
CBA was associated with equivalent 1-year FFAF rate as RFA for pAF. Procedure and fluoroscopy times were shorter for CBA and fewer cardiac perforations occurred.
导管消融是心房颤动（AF）的一种既定治疗方法。冷冻球囊消融（CBA）已成为射频消融（RFA）的替代方法。然而，在美国，比较这两种方式治疗阵发性房颤（pAF）的数据很少。
本研究的目的是比较CBA与RFA的手术时间、安全性和疗效。
一项单中心前瞻性队列研究评估了2010年1月1日至2013年10月31日期间接受CBA或RFA治疗pAF的患者。排除既往有消融史以及未进行至少3个月心律随访的患者。主要终点是在3个月的空白期后，无需使用抗心律失常药物，房颤、房扑和房性心动过速（FFAF）>30秒的无发作情况。我们还比较了成功肺静脉隔离（PVI）的发生率、透视和手术时间以及主要并发症发生率。
共纳入201例患者（CBA组101例，RFA组100例）。CBA组成功PVI的发生率为99.3%，RFA组为97.4%（P = 0.08）。CBA的手术时间较短（192.9±44.0分钟对283.7±78.0分钟，P < 0.001），总透视时间也较短（46.0±22.4分钟对73.0±30.1分钟，P < 0.001）。总体并发症发生率相当；然而，CBA发生心脏穿孔的情况较少（0%对4%，P = 0.042）。CBA组1年FFAF发生率为60.3%，RFA组为61.1%（对数秩检验P = 0.93）。
对于pAF，CBA与RFA的1年FFAF发生率相当。CBA的手术和透视时间较短，心脏穿孔发生较少。
