Pott Alexander, Messemer Marvin, Petscher Kerstin, Iturbe-Orbe Mario, Bothner Carlo, Rottbauer Wolfgang, Dahme Tillman
Department of Medicine II, Ulm University Medical Center, Ulm, Germany.
Department of Medicine II, Ulm University Medical Center, Ulm, Germany.
J Cardiol. 2017 Jan;69(1):24-29. doi: 10.1016/j.jjcc.2016.07.020. Epub 2016 Sep 17.
Pulmonary vein isolation is an established therapy for symptomatic atrial fibrillation. Despite the fact that incidence and prevalence of atrial fibrillation increases with age, patients over 75 years of age have been excluded in all major atrial fibrillation ablation trials. Pulmonary vein isolation with the cryoballoon has been shown to be equally effective compared to irrigated radiofrequency catheter ablation, but patients over 75 years have also been excluded. The 2nd generation cryoballoon has shown superior efficacy compared to the 1st generation cryoballoon. The aim of the study was to assess the efficacy of pulmonary vein isolation with the 2nd generation cryoballoon for symptomatic atrial fibrillation in elderly patients over 75 years.
Patients over 75 years of age presenting with symptomatic paroxysmal or persistent atrial fibrillation refractory or intolerant to at least one class I or class III antiarrhythmic drug who underwent pulmonary vein isolation with the 2nd generation cryoballoon were included in this single-center observational study.
A total of 40 patients with a mean age of 78.3±2.7 years with paroxysmal (n=31; 77.5%) or persistent (n=9; 22.5%) atrial fibrillation were identified. All patients had a successful pulmonary vein isolation procedure with 100% of veins isolated. After a 3-month blanking period during a mean follow-up of 15.1±8.2 months there were 9 (22.5%) arrhythmia recurrences, while 31 patients (77.5%) maintained stable sinus rhythm. Freedom from arrhythmia recurrence was 86.4% at 12 months and 80.2% at 24 months.
Pulmonary vein isolation with the 2nd generation cryoballoon appears to be an effective treatment for symptomatic atrial fibrillation also in patients over 75 years of age.
肺静脉隔离是一种已确立的有症状心房颤动的治疗方法。尽管心房颤动的发病率和患病率随年龄增长而增加，但在所有主要的心房颤动消融试验中，75岁以上的患者都被排除在外。与灌注式射频导管消融相比，冷冻球囊肺静脉隔离已被证明具有同等疗效，但75岁以上的患者也被排除在外。第二代冷冻球囊已显示出比第一代冷冻球囊更高的疗效。本研究的目的是评估第二代冷冻球囊肺静脉隔离对75岁以上老年有症状心房颤动患者的疗效。
本单中心观察性研究纳入了75岁以上有症状的阵发性或持续性心房颤动患者，这些患者对至少一种I类或III类抗心律失常药物难治或不耐受，并接受了第二代冷冻球囊肺静脉隔离治疗。
共确定了40例平均年龄为78.3±2.7岁的患者，其中阵发性心房颤动患者31例（77.5%），持续性心房颤动患者9例（22.5%）。所有患者的肺静脉隔离手术均成功，100%的肺静脉被隔离。在平均随访15.1±8.2个月的3个月空白期后，有9例（22.5%）心律失常复发，而31例（77.5%）患者维持稳定的窦性心律。12个月时无心律失常复发率为86.4%，24个月时为80.2%。
第二代冷冻球囊肺静脉隔离似乎也是75岁以上有症状心房颤动患者的一种有效治疗方法。
