Güler Ekrem, Güler Gamze Babur, Demir Gültekin Günhan, Kizilirmak Filiz, Güneş Haci Murat, Barutçu Irfan, Kiliçaslan Fethi
Medipol University Medicine Faculty, Cardiology Clinic, İstanbul, Turkey.
Pacing Clin Electrophysiol. 2015 Aug;38(8):989-96. doi: 10.1111/pace.12660. Epub 2015 Jun 12.
In this study, we aimed to determine pulmonary vein (PV) variation patterns in patients undergoing cryoballoon ablation for atrial fibrillation (AF) and their impacts on procedural success and recurrence and also to identify predictors for recurrence.
We enrolled 54 patients with AF and having symptoms despite medical therapy. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by computed tomography scan. Ablation procedure was performed with single balloon and predictors for AF recurrence were determined.
The study population consisted of 54 patients (male: 50 [27%], mean age: 53 ± 12) with AF. Paroxysmal AF and persistent AF were detected in 55.6% (30) and 44.4% (24) of the patients, respectively. Mean procedural and fluoroscopy times were 73 ± 19 minutes and 16 ± 4 minutes, respectively. The number of the patients with PV variation of right pulmonary vein (RPV) with >2 ostia and accessory PV was 27.8% (15) and 18.5% (10). During the follow-up, 20.4% (11) of patients had AF recurrence. Patients with recurrence had greater transverse LA size (62 ± 6 mm vs 57 ± 5 mm, P: 0014), longitudinal LA size (65 ± 5 mm vs 61 ± 6 mm, P: 0025), LA volume (78 ± 17 mL vs 65 ± 14 mL, P: 0011), fluoroscopy time (20.4 ± 4.6 minutes vs 15.7 ± 3.5 minutes, P: 0001), RPV with >2 ostia (72.7% vs 27.3%, P: 0001), right upper pulmonary vein (RUPV) diameter (21.6 ± 2.8 cm vs 15.8 ± 2.1 cm; P < 0001), and persistent AF (33.3% vs 66.7%, P: 0046). In multivariate analysis, RUPV diameter (β: 1006; P: 0010; odds ratio [OR]: 2736; 95% confidence interval [CI]: [1267-5906]) and fluoroscopy time (β: 0327; P: 0050; OR: 1386; 95% CI: [1000-1921]) were determined as independent predictors for AF recurrence.
Transverse and longitudinal LA size, LA volume, fluoroscopy time, presence of persistent AF, RUPV size, and the number of RPV ostia are associated with AF recurrence following cryoballoon-based ablation. RUPV size and fluoroscopy time are predictors for recurrence.
在本研究中，我们旨在确定接受冷冻球囊消融治疗心房颤动（AF）患者的肺静脉（PV）变异模式及其对手术成功率和复发率的影响，并确定复发的预测因素。
我们纳入了54例尽管接受药物治疗仍有症状的AF患者。在手术前，通过计算机断层扫描评估所有患者的PV变异和左心房（LA）大小。采用单球囊进行消融手术，并确定AF复发的预测因素。
研究人群包括54例AF患者（男性：50例[27%]，平均年龄：53±12岁）。阵发性AF和持续性AF分别在55.6%（30例）和44.4%（24例）的患者中被检测到。平均手术时间和透视时间分别为73±19分钟和16±4分钟。右肺静脉（RPV）有>2个开口和副PV的PV变异患者数量分别为27.8%（15例）和18.5%（10例）。在随访期间，20.4%（11例）的患者出现AF复发。复发患者的LA横径更大（62±6mm对57±5mm，P：0.014），LA纵径更大（65±5mm对61±6mm，P：0.025），LA容积更大（78±17mL对65±14mL，P：0.011），透视时间更长（20.4±4.6分钟对15.7±3.5分钟，P：0.0001），RPV有>2个开口（72.7%对27.3%，P：0.0001），右上肺静脉（RUPV）直径更大（21.6±2.8cm对15.8±2.1cm；P<0.0001），以及持续性AF（33.3%对66.7%，P：0.046）。在多变量分析中，RUPV直径（β：1.006；P：0.010；比值比[OR]：2.736；95%置信区间[CI]：[1.267 - 5.906]）和透视时间（β：0.327；P：0.050；OR：1.386；95%CI：[1.000 - 1.921]）被确定为AF复发的独立预测因素。
LA的横径和纵径、LA容积、透视时间、持续性AF的存在、RUPV大小以及RPV开口数量与基于冷冻球囊的消融术后AF复发相关。RUPV大小和透视时间是复发的预测因素。
