Department of Cardiology, ZNA Middelheim Hospital, Lindendreef 1, Antwerp, Belgium.
Department of Cardiology, Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, Jette, Belgium.
Europace. 2018 Aug 1;20(8):1279-1286. doi: 10.1093/europace/eux233.
To define predictors of complications of pulmonary vein isolation (PVI) and compare safety between different ablation techniques.
One thousand patients with atrial fibrillation (AF) (age 60 ± 10, 72% males, CHA2DS2-VASc score 1 ± 1) underwent PVI using various techniques: conventional PVI (CPVI) using mapping with irrigated point-per-point RF ablation (n = 576), multi-electrode RF ablation with the pulmonary vein ablation catheter (PVAC) (n = 272) or high density mesh ablator (HDMA) (n = 59) and cryoballoon (CB) ablation (n = 93). A complication was defined as any procedure-related adverse event resulting in permanent injury or death, requiring intervention or treatment, or prolonging/requiring hospitalization for >48 h. A total of 105 (10.5%) complications occurred in 101 (10.1%) patients. No periprocedural death occurred. Most frequent complications were vascular complications (4%) and pericarditis (3.1%). Seven patients experienced permanent deficit due to PV stenosis (n = 3, 1 CPVI, 2 PVAC) (n = 3) and phrenic nerve palsy (PNP) (n = 4, 3 CPVI, 1 PVAC). Independent predictors of complications were female sex [odds ratio (OR) = 1.73; 95% confidence interval (CI) 1.08-2.79; P = 0.023], CHA2DS2-VASc score (OR = 1.24; 95% CI 1.01-1.52; P = 0.039), and ablation technique (P = 0.006) in multivariable-adjusted analysis. Among the different techniques, CB (P = 0.047) and PVAC ablation (P = 0.003) had lowest overall complication rates. Complication profile (type/severity) differed between techniques (association between CB and PNP, CPVI and pericardial injury, PVAC and transient ischaemic attack/PV stenosis).
Overall complication rate of PVI with various techniques is 10.5%. Permanent deficit occurred only after PVAC and CPVI in 0.7% of patients. Female sex and a higher CHA2DS2-VASc score increase, while PVAC and CB-PVI decrease, overall risk. Differences in overall safety and individual complication profile make selection of the ablation technique in relation to clinical risk profile possible.
定义肺静脉隔离（PVI）并发症的预测因素，并比较不同消融技术的安全性。
1000 例房颤（AF）患者（年龄 60±10 岁，72%为男性，CHA2DS2-VASc 评分 1±1）接受了各种技术的 PVI：使用标测的常规 PVI（CPVI）+ 冷盐水灌注点消融（n=576）、使用肺静脉消融导管（PVAC）的多电极射频消融（n=272）或高密度网格消融器（HDMA）（n=59）和冷冻球囊消融（CB）（n=93）。并发症定义为任何与手术相关的不良事件，导致永久性损伤或死亡，需要干预或治疗，或延长/需要住院>48 小时。101 例（10.1%）患者发生了 105 例（10.5%）并发症。无围手术期死亡。最常见的并发症是血管并发症（4%）和心包炎（3.1%）。7 例患者因 PV 狭窄（n=3，1 例 CPVI，2 例 PVAC）（n=3）和膈神经麻痹（PNP）（n=4，3 例 CPVI，1 例 PVAC）导致永久性损伤。多变量调整分析显示，并发症的独立预测因素是女性（比值比（OR）=1.73；95%置信区间（CI）1.08-2.79；P=0.023）、CHA2DS2-VASc 评分（OR=1.24；95%CI 1.01-1.52；P=0.039）和消融技术（P=0.006）。在不同技术中，CB（P=0.047）和 PVAC 消融（P=0.003）的总体并发症发生率最低。不同技术之间的并发症谱（类型/严重程度）不同（CB 与 PNP、CPVI 与心包损伤、PVAC 与短暂性脑缺血发作/ PV 狭窄之间存在关联）。
各种技术的 PVI 总体并发症发生率为 10.5%。只有在 PVAC 和 CPVI 后，才会出现 0.7%的患者永久性损伤。女性和更高的 CHA2DS2-VASc 评分会增加总体风险，而 PVAC 和 CB-PVI 则会降低总体风险。安全性的总体差异和个体并发症谱使得根据临床风险谱选择消融技术成为可能。
