第二代冷冻球囊与开放式灌注射频消融治疗心房颤动的急性和长期疗效：一项多中心经验
Acute and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second-Generation Cryoballoon versus Open-Irrigated Radiofrequency: A Multicenter Experience.
作者信息
Aryana Arash, Singh Sheldon M, Kowalski Marcin, Pujara Deep K, Cohen Andrew I, Singh Steve K, Aleong Ryan G, Banker Rajesh S, Fuenzalida Charles E, Prager Nelson A, Bowers Mark R, D'Avila André, O'Neill Padraig Gearoid
机构信息
Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA.
Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
出版信息
J Cardiovasc Electrophysiol. 2015 Aug;26(8):832-839. doi: 10.1111/jce.12695. Epub 2015 Jun 4.
INTRODUCTION
There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies.
METHODS AND RESULTS
In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and open-irrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001).
CONCLUSION
In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone.
引言
关于使用第二代冷冻球囊（CB - 2）与逐点射频（RF）进行心房颤动导管消融（CAAF）的比较数据有限。本研究探讨了使用这两种策略的CAAF急性/长期结果。
方法与结果
在这项多中心、回顾性、非随机分析中，评估了1196例接受CAAF的患者（76%为阵发性房颤）的手术过程和临床结果，其中使用CB - 2的患者有773例，使用开放式灌注、非压力感应射频的患者有423例。CB - 2组实现肺静脉隔离的比例为98%，RF组为99%（P = 0.168）。CB - 2与较短的消融时间（40±14分钟 vs. 66±26分钟；P < 0.001）和手术时间（145±49分钟 vs. 188±42分钟；P < 0.001）相关，但荧光透视使用时间更长（29±13分钟 vs. 23±14分钟；P < 0.001）。虽然膈神经麻痹仅在CB - 2组出现短暂性（7.6% vs. 0%；P < 0.001）和持续性（1.2% vs. 0%；P = 0.026）情况，但CB - 2组（1.6%）和RF组（2.6%）的其他不良事件发生率相似；P = 0.207。然而，在单次手术后12个月，未使用抗心律失常治疗时，CB - 2组无房颤/房扑/心动过速的比例（76.6%）高于RF组（60.4%）；P < 0.001。虽然这种差异在阵发性房颤患者中很明显（P < 0.001），但在持续性房颤患者中未达到显著水平（P = 0.089）。此外，CB - 2与长期抗心律失常治疗需求减少（16.7% vs. 22.0%；P = 0.024）和重复消融需求减少（14.6% vs. 24.1%；P < 0.001）相关。
结论
在这项多中心、回顾性、非随机研究中，与单独使用开放式灌注非压力感应射频相比，使用CB - 2并在必要时联合RF进行CAAF，在单次手术后12个月未使用抗心律失常治疗时，无房性心律失常的比例更高。
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