Mugnai Giacomo, de Asmundis Carlo, Iacopino Saverio, Stroker Erwin, Longobardi Massimo, De Regibus Valentina, Coutino-Moreno Hugo Enrique, Takarada Ken, Choudhury Rajin, Abugattas de Torres Juan Pablo, Storti Cesare, Brugada Pedro, Chierchia Gian-Battista
Heart Rhythm Management Center, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium; Electrophysiology and Cardiac Pacing Unit, Cardiology Department, Istituto di Cura Città di Pavia, Pavia, Italy.
Heart Rhythm Management Center, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium.
Am J Cardiol. 2017 Jul 15;120(2):223-229. doi: 10.1016/j.amjcard.2017.04.012. Epub 2017 Apr 27.
Data evaluating the impact of the periprocedural administration of novel oral anticoagulants (NOACs) on complications in the setting of pulmonary vein (PV) isolation using cryoballoon (CB) is limited. In the present study, our aim was to analyze procedural characteristics and incidence of complications in those patients who underwent CB ablation for atrial fibrillation and the impact of NOACs on adverse events compared with vitamin K antagonists (VKAs). Consecutive patients with drug resistant atrial fibrillation who underwent PV isolation by CB as index procedure were retrospectively included in our analysis. In group I, 290 of 454 patients (63.9%) received VKAs (warfarin: n = 222 and acenocoumarol: n = 68), and in group II, 164 of 454 patients (36.1%) were treated with NOACs (rivaroxaban: n = 71; dabigatran: n = 60; and apixaban: n = 33). Age was significantly higher in the group II (62.8 ± 9.7 vs 58.6 ± 11.3; p <0.001). During the study period, 454 consecutive patients (male 71%, age 60.1 ± 10.9 years) were enrolled. Major complications occurred in 9 patients (2.0%): peripheral vascular complications were observed in 6 patients (1.3% per procedure), persistent phrenic nerve palsy occurred in 2 (0.4%), and transient ischemic attacks in 1 (0.2%). In both groups, the incidence of major complications was similar (group I [VKAs]: 7 patients [2.4%] vs group II [NOACs]: 2 patients [1.2%]; p = 0.5). In conclusion, CB ablation is a safe procedure for PV isolation and is associated with low complication rates. The incidence of adverse events in PV isolation using the second-generation CB with the periprocedural administration of NOACs is not significantly different than VKA treatment.
评估新型口服抗凝剂（NOACs）围手术期给药对使用冷冻球囊（CB）进行肺静脉（PV）隔离时并发症影响的数据有限。在本研究中，我们的目的是分析接受CB消融治疗房颤患者的手术特征和并发症发生率，以及与维生素K拮抗剂（VKAs）相比，NOACs对不良事件的影响。连续纳入以CB进行PV隔离作为索引手术的药物难治性房颤患者进行分析。在第一组中，454例患者中的290例（63.9%）接受VKAs治疗（华法林：n = 222，醋硝香豆素：n = 68），在第二组中，454例患者中的164例（36.1%）接受NOACs治疗（利伐沙班：n = 71；达比加群：n = 60；阿哌沙班：n = 33）。第二组患者年龄显著更高（62.8±9.7岁对58.6±11.3岁；p<0.001）。在研究期间，连续纳入454例患者（男性71%，年龄60.1±10.9岁）。9例患者（2.0%）发生主要并发症：6例患者（每次手术1.3%）出现外周血管并发症，2例（0.4%）发生持续性膈神经麻痹，1例（0.2%）发生短暂性脑缺血发作。两组主要并发症发生率相似（第一组[VKAs]：7例患者[2.4%]对第二组[NOACs]：2例患者[1.2%]；p = 0.5）。总之，CB消融是一种安全的PV隔离手术，并发症发生率低。使用第二代CB并在围手术期给予NOACs进行PV隔离时不良事件的发生率与VKA治疗无显著差异。
