Paylos Jesus M, Morales Aracelis, Azcona Luis, Paradela Marisol, Yagüe Raquel, Gómez-Guijarro Fernando, Lacal Lourdes, Clara Ferrero R N, Rodríguez Octavio
Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center.
J Atr Fibrillation. 2016 Apr 30;8(6):1400. doi: 10.4022/jafib.1400. eCollection 2016 Apr-May.
Cryoballoon ablation (CB) has proven effective for treating patients with paroxysmal atrial fibrillation (PAF). We analyzed our seven year follow-up of patients, treated for PAF with first (CB1) and second generation (CB2), with demonstration of LA-PV disconnection with bidirectional block (BB) after adenosine (AD).
Since November 2008 to May 2015, 128 patients, 97 male (58±7 years), without heart disease, highly symptomatic, refractory to antiarrhythmic drugs (AAD) were treated, and follow-up (1411 ±727 days). Left atrial size: 37±6 mm.
A total of 439 PV were successfully isolated (91.9%). Acute reconduction: 44 PV (9%): 16 after CB; 16 unmasked by AD; 12 extrapulmonary muscular connections (EMC). Main complication was phrenic nerve palsy (PNP): 9 (7 %). On follow-up, 114 patients (89%) remain asymptomatic in sinus rhythm (SR), free of medication. Fourteen patients (11%) had arrhythmia recurrence: 12 male (52±8 years). Early recurrences occurred in 9 male. Late recurrences presented 3 male at 24, 27 and 60 months, and 2 female at 7 and 40 months respectively. All recurrence patients were Redo, and remain in SR without medication during follow-up.
CB alone is very effective and safe for the definitive treatment of patients suffering PAF with 72.6% success rate, increasing up to 89.1% when this protocol is applied in a single procedure. After Redo, all population group (100%), remain in sinus rhythm, freedom of arrhythmia, without AAD, in this very long term follow-up. Checking for BB, AD protocol, and ruling out EMC allowed-us to identified 14.8% of patients with underlying substrate for potential arrhythmia recurrence. CB2 applications entail a highest risk of PNP. Patients with a rough estimated profile of low ALARMEc score (≤ 1) have an excellent long term outcome, being this series the largest follow-up described so far, for patients treated for PAF with CB.
冷冻球囊消融术（CB）已被证明对治疗阵发性心房颤动（PAF）患者有效。我们分析了对PAF患者进行第一代（CB1）和第二代（CB2）治疗的七年随访情况，证明在给予腺苷（AD）后实现了左心房-肺静脉双向阻滞（BB）下的肺静脉隔离。
自2008年11月至2015年5月，对128例患者进行了治疗，其中男性97例（58±7岁），无心脏病，症状严重，对抗心律失常药物（AAD）难治，随访时间为（1411±727天）。左心房大小：37±6mm。
共成功隔离439条肺静脉（91.9%）。急性再传导：44条肺静脉（9%）：16条在CB术后；16条被AD揭示；12条为肺外肌肉连接（EMC）。主要并发症为膈神经麻痹（PNP）：9例（7%）。在随访中，114例患者（89%）在窦性心律（SR）下无症状，无需用药。14例患者（11%）出现心律失常复发：12例男性（52±8岁）。9例男性出现早期复发。晚期复发分别为3例男性，时间为24、27和60个月，2例女性，时间为7和40个月。所有复发患者均接受再次手术，随访期间在无用药情况下维持窦性心律。
单独使用CB对PAF患者的确定性治疗非常有效且安全，成功率为72.6%，若在单次手术中应用该方案，成功率可提高至89.1%。在本次长期随访中，再次手术后所有患者群体（100%）均维持窦性心律，无心律失常，无需使用AAD。检查BB、AD方案并排除EMC使我们能够识别出14.8%有潜在心律失常复发基础的患者。应用CB2有更高的PNP风险。粗略估计ALARMEc评分低（≤1）的患者有出色的长期预后，本系列是迄今为止描述的接受CB治疗PAF患者的最大规模随访。
