Straube Florian, Hartl Stefan, Dorwarth Uwe, Wankerl Michael, Bunz Benedikt, Ebersberger Ullrich, Hoffmann Ellen
Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.
J Cardiol. 2016 Dec;68(6):492-497. doi: 10.1016/j.jjcc.2016.02.007. Epub 2016 Mar 11.
Different catheter ablation (CA) strategies have been established in the treatment of persistent atrial fibrillation (persAF). Pulmonary vein isolation (PVI) only might be an option for the initial ablation procedure. There is a paucity of outcome data on second-generation cryoballoon (CBG2) PVI in persAF.
Patients with symptomatic drug-refractory persAF who underwent initial CA of AF were prospectively enrolled and PVI was performed with CBG2. The primary composite endpoint was freedom from AF, atrial tachycardia, or related symptoms after a 3-month blanking period. The secondary endpoint referred to periprocedural complications.
One hundred seventy-three consecutive patients (64±10 years, 29% female) with symptomatic drug-refractory persAF were identified. Acute PVI was achieved in 100% of pulmonary veins with the CB technique. The left atrial procedure time was 112±30min. Major complications occurred in 1.7% (3 of 173 patients) including two phrenic nerve palsies (1%), which resolved until discharge, and one pericardial effusion (0.6%). Follow-up ≥12 months was completed for 157 of 173 patients (91%). Median follow-up was 14 months. At 12 months, the primary composite endpoint was achieved in 129 of 157 patients (82%). However, 22 of 129 patients at risk (17%) were still on antiarrhythmic drugs. A relapse during the blanking period was identified as the only independent predictor for AF recurrence.
PVI using the second-generation cryoballoon is a reasonable treatment option for patients with symptomatic drug-refractory persAF with a favorable rate of freedom from AF and a low complication rate.
在持续性心房颤动（persAF）的治疗中已确立了不同的导管消融（CA）策略。仅肺静脉隔离（PVI）可能是初始消融手术的一种选择。关于第二代冷冻球囊（CBG2）在persAF中进行PVI的疗效数据较少。
对有症状的药物难治性persAF且接受AF初始CA治疗的患者进行前瞻性登记，并使用CBG2进行PVI。主要复合终点是在3个月的空白期后无房颤、房性心动过速或相关症状。次要终点是指围手术期并发症。
确定了173例连续的有症状的药物难治性persAF患者（64±10岁，29%为女性）。采用CB技术在100%的肺静脉中实现了急性PVI。左心房手术时间为112±30分钟。主要并发症发生率为1.7%（173例患者中的3例），包括2例膈神经麻痹（1%），出院前恢复，1例心包积液（0.6%）。173例患者中的157例（91%）完成了≥12个月的随访。中位随访时间为14个月。在12个月时，157例患者中的129例（82%）达到主要复合终点。然而，129例有风险的患者中有22例（17%）仍在服用抗心律失常药物。空白期复发是AF复发的唯一独立预测因素。
对于有症状的药物难治性persAF患者，使用第二代冷冻球囊进行PVI是一种合理的治疗选择，房颤缓解率良好且并发症发生率低。
