Guler Tümer Erdem, Aksu Tolga, Yalin Kivanc, Golcuk Sukriye Ebru, Mutluer Ferit Onur, Bozyel Serdar
Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey.
Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, Kocaeli, Turkey.
Am J Med Sci. 2017 Dec;354(6):586-596. doi: 10.1016/j.amjms.2017.08.010. Epub 2017 Aug 19.
To achieve sinus rhythm, ablation of long-standing persistent atrial fibrillation (LSPAF) usually requires substrate modification in addition to pulmonary vein isolation (PVI). In the present article, we aimed to compare clinical and substrate modification effects of 2 distinct PVI strategies during stepwise ablation in patients with LSPAF: (1) Combined approach: cryoballoon (CB) for PVI and radiofrequency (RF) ablation for substrate modification and (2) RF-only approach: RF ablation for both PVI and substrate modification.
A total of 34 patients were divided into 2 groups: 19 in the combined group and 15 in the RF group. Left atrial (LA) complex fractionated atrial electrogram (CFAE) maps were acquired before and after PVI and compared between groups. The groups were compared for acute atrial fibrillation termination (AFT) rates and long-term arrhythmia-free survival.
A significant reduction on total LA CFAE area was observed with PVI in both groups. In the CB group, when pulmonary veins were excluded, the reduction of LA CFAE area was the most significant on the posterior wall of left atrium and which was greater than in the RF group. Although the ratio of AFT was higher in the CB group (44% versus 33%, respectively), single-procedure arrhythmia-free survival at 1 year was comparable between groups (68% in the CB group versus 66% in the RF group). Times of total procedure, fluoroscopy and post-PVI RF were all shorter in the CB group.
CB may cause greater substrate modification on the posterior wall and increase AFT rate during LSPAF ablation.
为实现窦性心律，对于长期持续性房颤（LSPAF）的消融，除肺静脉隔离（PVI）外通常还需要对基质进行改良。在本文中，我们旨在比较LSPAF患者逐步消融过程中两种不同PVI策略的临床效果和基质改良效果：（1）联合方法：使用冷冻球囊（CB）进行PVI，使用射频（RF）消融进行基质改良；（2）单纯RF方法：使用RF消融进行PVI和基质改良。
总共34例患者被分为2组：联合组19例，RF组15例。在PVI前后获取左心房（LA）碎裂心房电图（CFAE）图，并在组间进行比较。比较两组的急性房颤终止（AFT）率和长期无心律失常生存率。
两组在PVI后总LA CFAE面积均显著减少。在CB组，排除肺静脉后，LA CFAE面积减少在左心房后壁最为显著，且大于RF组。虽然CB组的AFT比例较高（分别为44%对33%），但两组1年单手术无心律失常生存率相当（CB组为68%，RF组为66%）。CB组的总手术时间、透视时间和PVI后RF时间均较短。
在LSPAF消融过程中，CB可能对后壁造成更大的基质改良并提高AFT率。
