Paylos Jesus M, Azcona Luis, Lacal Lourdes, Paradela Marisol, Cilleros Carmen, Del-Campo Ildefonso, Carlos Martínez Clara Ferrero Rn, Morales Aracelis
Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center.
J Atr Fibrillation. 2016 Apr 30;8(6):1399. doi: 10.4022/jafib.1399. eCollection 2016 Apr-May.
Introduction Cryoballoon ablation (CB) has proven effective to treatment of patients (pts) with atrial fibrillation (AF). However, the isolated efficacy of CB to treat pts with long-standing persistent atrial fibrillation (LSPAF) is less know. We analyzed the acute results and the long-term follow-up of our pts suffering LSPAF and initially treated with CB. Methods A cohort of 44 pts, 37 male (84%) mean age (60±10 year) suffering LSPAF were treated with first (CB1): 15pts, and second (CB2): 29 pts, generation CB. Eight pts (18.1%) had structural heart disease. Prior to CB, all pts were previously electrically cardioverted (CV) and sinus node and A-V nodal function evaluated at electrophysiological study (EP) once in sinus rhythm (SR) before antiarrhythmic drugs (AAD) load. CB ablation procedure was performed after three months waiting period on AAD following CV/EP drug testing. Result CB procedure was performed in 27 (61.4%) in AF, restoring SR in 8 (18.2%). PV isolation (PVI) was achieved in 95.2%. On follow-up of 30±39 months, 16 pts (40%) had AF recurrence. Second procedure (Redo) was performed in 7 pts. After a single procedure, 24 pts (60%) remain in SR without AAD, after Redo, 29 pts (72.5%), and when AAD added, 31 pts (77.5%) remain in SR. Phrenic nerve palsy (PNP) occurred in 9% of pts (75% with CB2). Conclusion CB technique is safe and useful tool to treat pts with LSPAF with 60% success rate maintaining SR without AAD in a long-term follow-up (30±39 months), up to 72.5% after Redo, and to 77.5% when AAD are added. In the majority of pts maintaining SR (77.5%) CB2 was used in 87% of the cases. Patients without structural heart disease along with those who SR was restored during CB showed the best result.
引言 冷冻球囊消融术（CB）已被证明对心房颤动（AF）患者的治疗有效。然而，CB治疗长期持续性心房颤动（LSPAF）患者的单独疗效尚鲜为人知。我们分析了最初接受CB治疗的LSPAF患者的急性结果和长期随访情况。方法 一组44例LSPAF患者，37例男性（84%），平均年龄（60±10岁），接受第一代CB（CB1）治疗15例，第二代CB（CB2）治疗29例。8例（18.1%）患者有结构性心脏病。在进行CB之前，所有患者均曾接受电复律（CV），并在抗心律失常药物（AAD）负荷前窦性心律（SR）时进行一次电生理研究（EP）以评估窦房结和房室结功能。在CV/EP药物测试后等待三个月AAD治疗期后进行CB消融手术。结果 在27例（61.4%）处于AF状态的患者中进行了CB手术，8例（18.2%）恢复为SR。肺静脉隔离（PVI）成功率为95.2%。在30±39个月的随访中，16例（40%）患者出现AF复发。7例患者进行了二次手术（再次手术）。单次手术后，24例（60%）患者在未使用AAD的情况下维持SR，再次手术后，29例（72.5%）患者维持SR，添加AAD后，31例（77.5%）患者维持SR。膈神经麻痹（PNP）发生在9%的患者中（75%发生在使用CB2的患者中）。结论 CB技术是治疗LSPAF患者的安全且有用的工具，在长期随访（30±39个月）中，60%的患者在未使用AAD的情况下成功维持SR，再次手术后成功率高达72.5%，添加AAD后成功率为77.5%。在大多数维持SR的患者（77.5%）中，87%的病例使用了CB2。无结构性心脏病的患者以及在CB过程中恢复为SR的患者效果最佳。
