使用第二代冷冻球囊进行肺静脉隔离期间的循环动力学。

Circulatory Dynamics During Pulmonary Vein Isolation Using the Second-Generation Cryoballoon.

机构信息

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.

出版信息

J Am Heart Assoc. 2017 Oct 10;6(10):e006559. doi: 10.1161/JAHA.117.006559.

BACKGROUND

Circulatory dynamics change during pulmonary vein (PV) isolation using cryoballoons. This study sought to investigate the circulatory dynamics during cryoballoon-based PV isolation procedures and the contributing factors.

METHODS AND RESULTS

This study retrospectively included 35 atrial fibrillation patients who underwent PV isolation with 28-mm second-generation cryoballoons and single 3-minute freeze techniques. Blood pressures were continuously monitored via arterial lines. The left ventricular function was evaluated with intracardiac echocardiography throughout the procedure in 5 additional patients. Overall, 126 cryoapplications without interrupting freezing were analyzed. Systolic blood pressure (SBP) significantly increased during freezing (138.7±28.0 to 148.0±27.2 mm Hg, <0.001) and sharply dropped (136.3±26.0 to 95.0±17.9 mm Hg, <0.001) during a mean of 21.0±8.0 seconds after releasing the occlusion during thawing. In the multivariate analyses, the left PVs (=0.008) and lower baseline SBP (<0.001) correlated with a larger SBP rise, whereas a higher baseline SBP (<0.001), left PVs (=0.017), lower balloon nadir temperature (=0.027), and female sex (=0.045) correlated with larger SBP drops. These changes were similarly observed regardless of preprocedural atropine administration and the target PV order. PV occlusions without freezing exhibited no SBP change. PV antrum freezing without occlusions similarly increased the SBP, but the SBP drop was significantly smaller than that with occlusions (<0.001). The SBP drop time-course paralleled the left ventricular ejection fraction increase (66.8±8.1% to 79.3±6.7%, <0.001) and systemic vascular resistance index decrease (2667±1024 to 1937±513 dynes-sec/cm per m, =0.002).

CONCLUSIONS

With second-generation cryoballoon-based PV isolation, SBP significantly increased during freezing owing to atrial tissue freezing and dropped sharply after releasing the occlusion, presumably because of the peripheral vascular resistance decrease mainly by circulating chilled blood.

背景

在使用冷冻球囊进行肺静脉（PV）隔离时，循环动力学发生变化。本研究旨在探讨冷冻球囊基础 PV 隔离过程中的循环动力学变化及其影响因素。

方法和结果

本研究回顾性纳入了 35 例接受 28-mm 第二代冷冻球囊和单次 3 分钟冷冻技术进行 PV 隔离的房颤患者。通过动脉线连续监测血压。在另外 5 例患者中，整个过程中使用心内超声心动图评估左心室功能。总共分析了 126 次无中断冷冻的冷冻球囊应用。冷冻过程中收缩压（SBP）显著升高（从 138.7±28.0 增加至 148.0±27.2mmHg，<0.001），在解冻过程中松开阻塞后平均 21.0±8.0 秒时急剧下降（从 136.3±26.0 下降至 95.0±17.9mmHg，<0.001）。多变量分析显示，左 PV（=0.008）和较低的基础 SBP（<0.001）与 SBP 升高相关，而较高的基础 SBP（<0.001）、左 PV（=0.017）、较低的球囊最低温度（=0.027）和女性（=0.045）与 SBP 下降较大相关。这些变化在术前给予阿托品与否以及目标 PV 顺序方面是相似的。无冷冻的 PV 闭塞不引起 SBP 变化。无冷冻的 PV 窦部冷冻同样增加 SBP，但 SBP 下降明显小于有冷冻的（<0.001）。SBP 下降时间进程与左心室射血分数增加（从 66.8±8.1%增加至 79.3±6.7%，<0.001）和全身血管阻力指数下降（从 2667±1024 下降至 1937±513 达因·秒·厘米/每米，=0.002）一致。