Curnis Antonio, Salghetti Francesca, Cerini Manuel, Vassanelli Francesca, Inama Lorenza, Villa Clara, Giacopelli Daniele, Raweh Abdallah, Bontempi Luca
aDivision of Cardiology, Spedali Civili Hospital, Brescia bClinical Research, Biotronik Italia, Milan, Italy cCardiac Surgery Department, LUDES University, Lugano, Switzerland.
J Cardiovasc Med (Hagerstown). 2017 Sep;18(9):655-662. doi: 10.2459/JCM.0000000000000542.
In this study, we aimed to compare the efficacy of single pulmonary vein isolation with the second-generation cryoballoon (CB-Adv) and predictors of atrial fibrillation recurrences in patients with paroxysmal (PAF) and persistent atrial fibrillation (PersAF).
Consecutive PAF and PersAF patients undergoing CB-Adv for the first time were enrolled. Patients were followed with in-clinic visits including Holter ECG. Atrial arrhythmic episodes symptomatic or documented lasting more than 30 s were considered as recurrences.
A total of 96 consecutive patients [77 men (80%), mean age 57.4 ± 9.9 years] were included in this analysis. About 56 (58%) patients had PAF and 40 had (42%) PersAF. The mean procedural and fluoroscopy times were 116 ± 24 and 33 ± 12 min, respectively. Procedure-related complications occurred in four (4.2%) patients.At the 12-month follow-up, after a 3-month blanking period, freedom from recurrences was achieved in 59% [confidence interval (CI): 49-69%] of patients, 62% (CI: 48-75%) in PAF, and 54% (CI: 38-71%) in PersAF group. The difference was not statistically significant at the Kaplan-Meier survival analysis (P = 0.242). Cardioversion to restore sinus rhythm was less frequently needed in PAF group [5% (CI: 1-15%) vs. 25% (CI: 13-41%), P < 0.001]. Redo procedure was performed in 7% (CI: 3-15%) of patients. In the Cox regression analysis, early atrial-tachyarrhythmia recurrence was the only independent predictor of 1-year recurrence (hazard ratio 2.11, CI: 1.06-4.20, P = 0.03).
The success rate at 12 months after a single CB-Adv procedure was 62% in patients with PAF and 54% in study participants with PersAF. Early atrial-tachyarrhythmia recurrence appeared to be the only independent predictor of late atrial fibrillation recurrence.
在本研究中，我们旨在比较第二代冷冻球囊（CB-Adv）进行单次肺静脉隔离的疗效以及阵发性房颤（PAF）和持续性房颤（PersAF）患者房颤复发的预测因素。
纳入首次接受CB-Adv治疗的连续性PAF和PersAF患者。患者通过门诊随访，包括动态心电图监测。有症状或记录到的持续超过30秒的房性心律失常发作被视为复发。
本分析共纳入96例连续性患者[77例男性（80%），平均年龄57.4±9.9岁]。约56例（58%）患者为PAF，40例（42%）为PersAF。平均手术时间和透视时间分别为116±24分钟和33±12分钟。4例（4.2%）患者发生了与手术相关的并发症。在12个月的随访中，经过3个月的空白期后，59%[置信区间（CI）：49-69%]的患者无复发，PAF患者为62%（CI：48-75%），PersAF组为54%（CI：38-71%）。在Kaplan-Meier生存分析中，差异无统计学意义（P = 0.242）。PAF组恢复窦性心律所需的复律频率较低[5%（CI：1-15%）对25%（CI：13-41%），P < 0.001]。7%（CI：3-15%）的患者进行了再次手术。在Cox回归分析中，早期房性快速性心律失常复发是1年复发的唯一独立预测因素（风险比2.11，CI：1.06-4.20，P = 0.03）。
单次CB-Adv手术后12个月，PAF患者的成功率为62%，PersAF患者为54%。早期房性快速性心律失常复发似乎是晚期房颤复发的唯一独立预测因素。
