Saygi Serkan, Bastani Hamid, Drca Nikola, Insulander Per, Wredlert Christer, Schwieler Jonas, Jensen-Urstad Mats
a All Department of Cardiology , Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden.
Scand Cardiovasc J. 2017 Apr;51(2):69-73. doi: 10.1080/14017431.2016.1259496. Epub 2016 Nov 25.
Cryoablation (CRYO) is an alternative to radiofrequency (RF) for catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). We aimed to study whether different CTI morphologies had different impacts on procedural success for CRYO and RF.
This study randomized 153 patients with CTI-dependent AFL (median age 65 years; range 34-82) to RF or CRYO (78 CRYO; 75 RF). Biplane angiography (RAO 30° and LAO 60°) was done before the ablation procedure and isthmuses were classified as straight (n = 81), concave (n = 43) or pouch-like (n = 29). RF was performed with a 3.5-mm open-irrigated tip catheter and CRYO was performed with a 9 F, 8-mm tip catheter. The ablation endpoint was bidirectional block of CTI.
Acute procedural success was achieved in 70/75 patients in the RF group and in 72/78 patients in the CRYO group. With regard to CRYO or RF, acute procedural success rates were similar between the three isthmus types: straight: CRYO (92%) and RF (96%); concave: CRYO (92%) and RF (94%); and pouch-like: CRYO (94%) and RF (85%). There were no significant differences regarding success rate between the different morphologies in the CRYO or the RF group. The CTI was longer in patients with acute failure compared to the patients with acute success (38 ± 7 mm versus 33 ± 6 mm, p = 0.045).
The CTI morphology did not influence the acute success rate for either the CRYO or the RF ablation of CTI-dependent AFL. A longer CTI was associated with a lower success rate regardless of energy source.
冷冻消融（CRYO）是用于三尖瓣峡部（CTI）依赖性房扑（AFL）导管消融的一种替代射频（RF）的方法。我们旨在研究不同的CTI形态对CRYO和RF手术成功率是否有不同影响。
本研究将153例CTI依赖性AFL患者（中位年龄65岁；范围34 - 82岁）随机分为RF组或CRYO组（78例CRYO；75例RF）。在消融手术前进行双平面血管造影（右前斜30°和左前斜60°），峡部分为直形（n = 81）、凹形（n = 43）或袋状（n = 29）。RF使用3.5毫米开放式灌注尖端导管进行，CRYO使用9F、8毫米尖端导管进行。消融终点为CTI双向阻滞。
RF组75例患者中有70例、CRYO组78例患者中有72例获得急性手术成功。对于CRYO或RF，三种峡部类型的急性手术成功率相似：直形：CRYO（92%）和RF（96%）；凹形：CRYO（92%）和RF（94%）；袋状：CRYO（94%）和RF（85%）。CRYO组或RF组不同形态之间的成功率无显著差异。与急性成功的患者相比，急性失败患者的CTI更长（38±7毫米对33±6毫米，p = 0.045）。
CTI形态不影响CRYO或RF消融CTI依赖性AFL的急性成功率。无论能量来源如何，较长的CTI与较低的成功率相关。
