Evranos Banu, Kocyigit Duygu, Gurses Kadri Murat, Yalcin Muhammed Ulvi, Sahiner Mehmet Levent, Kaya Ergun Baris, Ozer Necla, Aytemir Kudret
Department of Cardiology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Sihhiye, Turkey.
Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey.
J Interv Card Electrophysiol. 2016 Aug;46(2):145-51. doi: 10.1007/s10840-016-0107-8. Epub 2016 Jan 29.
Several studies have demonstrated that left ventricular diastolic dysfunction (LVDD) and left atrial pressure (LAP), as a surrogate marker of LVDD, were associated with atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) for AF. In this study, we aimed to investigate the individual impact of several left ventricular diastolic function parameters on outcomes of cryoablation for paroxysmal AF using second-generation cryoballoon.
One hundred seventy patients who were scheduled for cryoablation with second-generation cryoballoon were included in this prospective study. All patients underwent comprehensive transthoracic and transesophageal echocardiographic examinations during sinus rhythm a day before catheter ablation. LAP was measured via transseptal sheath at the beginning of the ablation procedure.
One hundred seventy patients (57.09 ± 11.80 years, 47.06 % male) were involved in the study. At a median follow-up of 19 months, when blanking period of 3 months was considered, freedom from AF after a single ablation procedure was 84.71 %. Patients with AF recurrence had significantly greater left atrial volume index (LAVI) (p = 0.005) and LAP (p < 0.001). Patients with AF recurrence had lower septal e' wave (p = 0.013), and higher E/e' ratio (p = 0.014). LAVI (p = 0.007) and LAP (p = 0.006) were independent predictors of AF recurrence. A cut-off value of 13.50 mmHg for LAP measured during the procedure was associated with a sensitivity and specificity of 80.8 and 84.7 % (p = 0.005) for predicting AF recurrence.
Pre-procedural LAVI and procedural LAP measurement have clinical importance in predicting AF recurrence in patients undergoing cryoablation with second-generation cryoballoon. Effectiveness of cryoablation is reduced in patients with greater LAVI and LAP.
多项研究表明，左心室舒张功能障碍（LVDD）以及作为LVDD替代指标的左心房压力（LAP）与房颤（AF）射频导管消融（RFCA）术后的房颤复发相关。在本研究中，我们旨在探讨多个左心室舒张功能参数对使用第二代冷冻球囊进行阵发性房颤冷冻消融结果的个体影响。
本前瞻性研究纳入了170例计划使用第二代冷冻球囊进行冷冻消融的患者。所有患者在导管消融前一天的窦性心律期间接受了全面的经胸和经食管超声心动图检查。在消融手术开始时通过经间隔鞘管测量LAP。
170例患者（年龄57.09±11.80岁，男性占47.06%）参与了本研究。在中位随访19个月时，若考虑3个月的空白期，单次消融术后无房颤的发生率为84.71%。房颤复发患者的左心房容积指数（LAVI）（p = 0.005）和LAP（p < 0.001）显著更高。房颤复发患者的室间隔e'波更低（p = 0.013），E/e'比值更高（p = 0.014）。LAVI（p = 0.007）和LAP（p = 0.006）是房颤复发的独立预测因素。手术过程中测量的LAP的截断值为13.50 mmHg时，预测房颤复发的敏感性和特异性分别为80.8%和84.7%（p = 0.005）。
术前LAVI和术中LAP测量对于预测使用第二代冷冻球囊进行冷冻消融的患者的房颤复发具有临床重要性。LAVI和LAP较高的患者冷冻消融的有效性降低。
