CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2 rue Henri Le Guilloux, Rennes, France.
Université de Rennes 1, Rennes, France.
Europace. 2018 Jul 1;20(7):1115-1121. doi: 10.1093/europace/eux200.
Pulmonary vein isolation (PVI) using second-generation cryoballoon (CB2) is associated with improved outcomes compared with first generation (CB1). We aimed at investigating the characteristics of left and right PV reconnections after CB1 and CB2 ablations in patients with clinical recurrences requiring redo ablation.
From 2010 to 2016, 776 patients underwent 28-mm cryoballoon PVI for symptomatic paroxysmal atrial fibrillation (AF) in 3 centres, 279 with CB1 and 497 with CB2. Among them, 94 patients (12.1%) had symptomatic AF recurrences requiring a redo ablation [43 (15.4%) CB1 and 51 (10.3%) CB2]. The benefit of CB2 over CB1 was compared for each PV. Durable PVI was confirmed in 7 CB1 (16.3%) and 14 CB2 (27.4%) patients, and 2.7 ± 2.1 and 1.4 ± 1.4 gaps per patient were found, respectively (P = 0.002). Significantly more left superior and left inferior PVs were found to be isolated in CB2 compared with CB1 group (78.4% vs. 48.8%, P = 0.005 and 78.4% vs. 46.5%, P = 0.003, respectively) while the rate of durable right superior and right inferior PVs isolation were similar (68.6% vs. 60.5%, P = 0.542 and 66.7% vs. 55.8%, P = 0.387, respectively). Significantly fewer gaps were found in left PVs in CB2 patients, while there was no significant difference for right PVs. Gaps localization was similar in both groups.
Fewer reconnection gaps are observed during redo ablations of paroxysmal AF in patients primarily ablated with CB2. This difference is driven by less reconnection gaps observed in both left PVs, while no difference was observed for right PVs.
与第一代（CB1）相比，使用第二代冷冻球囊（CB2）进行肺静脉隔离（PVI）与改善结果相关。我们旨在研究在需要再次消融的临床复发患者中，使用 CB1 和 CB2 消融后左、右 PV 再连接的特征。
2010 年至 2016 年，3 个中心的 776 例有症状阵发性心房颤动（AF）患者接受了 28-mm 冷冻球囊 PVI，其中 279 例使用 CB1，497 例使用 CB2。其中，94 例（12.1%）有症状 AF 复发需要再次消融[43 例（15.4%）使用 CB1，51 例（10.3%）使用 CB2]。比较了 CB2 与 CB1 对每个 PV 的益处。在 7 例 CB1（16.3%）和 14 例 CB2（27.4%）患者中确认了持久的 PVI，分别发现每个患者 2.7±2.1 和 1.4±1.4 个间隙（P=0.002）。与 CB1 组相比，CB2 组发现更多的左上肺静脉和左下肺静脉被隔离（78.4%对 48.8%，P=0.005 和 78.4%对 46.5%，P=0.003），而右肺静脉的持久隔离率相似（68.6%对 60.5%，P=0.542 和 66.7%对 55.8%，P=0.387）。在 CB2 患者中，左肺静脉的间隙明显减少，而右肺静脉无明显差异。两组的间隙定位相似。
在主要使用 CB2 消融的阵发性 AF 患者的再次消融中，观察到较少的再连接间隙。这种差异是由左肺静脉观察到的再连接间隙较少驱动的，而右肺静脉没有差异。
