采用前瞻性方案，以腺苷后完全双向左心房-肺静脉隔离为主要目标终点，对接受第一代和第二代冷冻球囊导管消融治疗阵发性心房颤动的患者进行长期随访。对低ALARMEc评分粗略估计的患者进行七年随访。单中心报告。
Long-Term Evolution of Patients Treated for Paroxysmal Atrial Fibrillation with First and Second Generation Cryoballoon Catheter Ablation with a Prospective Protocol Guided by Complete Bidirectional Left Atrium-Pulmonary Veins Disconnection after Adenosine as Main Target end Point to achieved. Seven Years Follow-up of Patients with a rough estimation profile of Low ALARMEc Score. A Single Center Report.
作者信息
Paylos Jesus M, Morales Aracelis, Azcona Luis, Paradela Marisol, Yagüe Raquel, Gómez-Guijarro Fernando, Lacal Lourdes, Clara Ferrero R N, Rodríguez Octavio
机构信息
Cardiac Electrophysiology Lab, Arrhythmia Unit and Atrial Fibrillation Center.
出版信息
J Atr Fibrillation. 2016 Apr 30;8(6):1400. doi: 10.4022/jafib.1400. eCollection 2016 Apr-May.
INTRODUCTION
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).
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
引言
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。
方法
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。
结果
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。
结论
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。
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