Aryana Arash, Singh Sheldon M, Mugnai Giacomo, de Asmundis Carlo, Kowalski Marcin, Pujara Deep K, Cohen Andrew I, Singh Steve K, Fuenzalida Charles E, Prager Nelson, Bowers Mark R, O'Neill Padraig Gearoid, Brugada Pedro, d'Avila André, Chierchia Gian-Battista
Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
J Interv Card Electrophysiol. 2016 Dec;47(3):341-348. doi: 10.1007/s10840-016-0172-z. Epub 2016 Jul 30.
Catheter ablation of atrial fibrillation (CAAF) using the cryoballoon has emerged as an alternate strategy to point-by-point radiofrequency. However, there is little comparative data on long-term durability of pulmonary vein (PV) isolation comparing these two modalities.
In this multicenter, retrospective analysis, the incidences/patterns of late PV reconnection following an index CAAF using the second-generation cryoballoon versus open-irrigated, non-force-sensing radiofrequency were examined.
Of the 2002 patients who underwent a first-time CAAF, 186/1126 patients (16.5 %) ablated using cryoballoon and 174/876 patients (19.9 %) with non-contact force-guided radiofrequency required a repeat procedure at 11 ± 5 months. During follow-up, the incidence of atrial flutters/tachycardias was lower (19.9 vs. 32.8 %; p = 0.005) and fewer patients exhibited PV reconnection (47.3 vs. 60.9 %; p = 0.007) with cryoballoon versus radiofrequency. Additionally, fewer PVs had reconnected with cryoballoon versus radiofrequency (18.8 vs. 34.6 %; p < 0.001). With cryoballoon, the right inferior (p < 0.001) and left common (p = 0.039) PVs were more likely to exhibit late reconnection, versus the left superior PV with radiofrequency (p = 0.012). However, when comparing the two strategies, the left common PV was more likely to exhibit reconnection with cryoballoon, whereas all other PVs with the exception of the right inferior PV demonstrated a lower reconnection rate with cryoballoon versus radiofrequency. Lastly, in a logistic regression multivariate analysis, cryoballoon ablation and PV ablation time emerged as significant predictors of durable PV isolation at repeat procedure.
In this large multicenter, retrospective analysis, CAAF using the second-generation cryoballoon was associated with improved durability of PV isolation compared to open-irrigated, non-force-sensing radiofrequency.
使用冷冻球囊进行心房颤动导管消融（CAAF）已成为逐点射频消融的替代策略。然而，关于比较这两种方式下肺静脉（PV）隔离长期耐久性的对比数据很少。
在这项多中心回顾性分析中，研究了使用第二代冷冻球囊与开放式灌注、非压力感应射频进行初次CAAF后晚期PV重新连接的发生率/模式。
在2002例接受首次CAAF的患者中，186/1126例（16.5%）使用冷冻球囊消融，174/876例（19.9%）使用非接触压力引导射频消融，在11±5个月时需要再次手术。随访期间，冷冻球囊消融组心房扑动/心动过速的发生率较低（19.9%对32.8%；p = 0.005），PV重新连接的患者较少（47.3%对60.9%；p = 0.007）。此外，与射频消融相比，冷冻球囊消融后重新连接的PV较少（18.8%对34.6%；p < 0.001）。使用冷冻球囊时，右下肺静脉（p < 0.001）和左总肺静脉（p = 0.039）比使用射频消融时左上肺静脉（p = 0.012）更易出现晚期重新连接。然而，比较这两种策略时，左总肺静脉使用冷冻球囊时更易重新连接，而除右下肺静脉外的所有其他肺静脉，冷冻球囊消融后的重新连接率低于射频消融。最后，在逻辑回归多变量分析中，冷冻球囊消融和PV消融时间是再次手术时持久PV隔离的重要预测因素。
在这项大型多中心回顾性分析中，与开放式灌注、非压力感应射频相比，使用第二代冷冻球囊进行CAAF与PV隔离耐久性的改善相关。
