Pieragnoli Paolo, Paoletti Perini Alessandro, Ricciardi Giuseppe, Checchi Luca, Giomi Andrea, Muraca Iacopo, Mannucci Letizia, Padeletti Luigi
Heart and Vessels Department, University of Florence, Florence, Italy.
Ospedale Santa Maria Nuova, Cardiology Unit, Florence, Italy.
J Cardiovasc Electrophysiol. 2017 Jun;28(6):625-633. doi: 10.1111/jce.13190. Epub 2017 Mar 20.
Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance of within-blanking recurrences at 12-month follow-up after cryoballoon (CB) PVI, and to assess the real procedural success rate by continuous monitoring of cardiac rhythm.
Sixty consecutive AF patients (34 paroxysmal, 56.7%) underwent their first CB-PVI at one Italian center (May 2013 to April 2015), and subsequent implantation of an implantable loop recorder (ILR). Overall, 12-month success rate after the blanking period was 55%. The shortest detected event was 7 minutes long. Late recurrences were more frequent in non-paroxysmal (19/26, 73.1%) than in paroxysmal AF (8/34, 23.5%; P <0.001). Early recurrences occurred in 17 (28.3%) patients, with 14 also having late recurrences (82.3%), while only 13 out of 43 (30.2%) without within-blanking recurrences experienced post-blanking events (P <0.001). Overall, early recurrences showed 51.8% sensitivity (95% CI 31.9-71.3%) and 90.9% specificity (95% CI 75.7-98.1%) for later recurrences, with 82.3% (95% CI 56.6-96.2%) positive and 69.8% (95% CI 53.9-82.8%) negative predictive value. The positive likelihood ratio was 5.7 (95% CI 1.8-17.8). At multivariable analysis, non-paroxysmal AF (HR: 3.113; 95% CI 1.309-7.403; P = 0.010) and within-blanking recurrences (HR: 3.453; 95% CI 1.544-7.722; P = 0.003) were independent predictors of post-blanking AT/AF.
CB-PVI for paroxysmal AF shows a 12-month success rate of 76.5% after one single procedure, as assessed by continuous cardiac rhythm monitoring. Within-blanking recurrences predict the ablation failure in more than 80% of patients.
在通过肺静脉隔离（PVI）进行心房颤动（AF）消融术后，空白期内的复发（早期复发）很常见，但其临床意义仍存在争议。我们旨在评估冷冻球囊（CB）PVI术后12个月随访时空白期内复发的意义，并通过持续监测心律来评估实际手术成功率。
60例连续的AF患者（34例阵发性，占56.7%）于意大利的一个中心（2013年5月至2015年4月）接受了首次CB-PVI治疗，并随后植入了植入式循环记录仪（ILR）。总体而言，空白期后的12个月成功率为55%。检测到的最短事件持续7分钟。非阵发性AF患者的晚期复发（19/26，73.1%）比阵发性AF患者（8/34，23.5%；P<0.001）更频繁。17例（28.3%）患者出现早期复发，其中14例（82.3%）也有晚期复发，而在43例无空白期内复发的患者中，只有13例（30.2%）出现了空白期后事件（P<0.001）。总体而言，早期复发对晚期复发的敏感性为51.8%（95%CI 31.9-71.3%），特异性为90.9%（95%CI 75.7-98.1%），阳性预测值为82.3%（95%CI 56.6-96.2%），阴性预测值为69.8%（95%CI 53.9-82.8%）。阳性似然比为5.7（95%CI 1.8-17.8）。在多变量分析中，非阵发性AF（HR：3.113；95%CI 1.309-7.403；P=0.010）和空白期内复发（HR：3.453；95%CI 1.544-7.722；P=0.003）是空白期后房性心动过速/AF的独立预测因素。
通过持续心律监测评估，阵发性AF的CB-PVI单次手术后12个月成功率为76.5%。空白期内复发可预测超过80%患者的消融失败。
