使用冷冻球囊消融治疗晚期收缩性心力衰竭合并心脏植入式电子设备患者的心房颤动。
Cryoballoon ablation of atrial fibrillation in patients with advanced systolic heart failure and cardiac implantable electronic devices.
机构信息
Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii SUM, Śląskie Centrum Chorób Serca w Zabrzu, Curie-Skłodowskie 9, 41-800 Zabrze, Poland.
出版信息
Kardiol Pol. 2018;76(7):1081-1088. doi: 10.5603/KP.a2018.0068. Epub 2018 Mar 12.
BACKGROUND
Pulmonary vein isolation with cryoballoon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF), but in patients with heart failure (HF) the role of CCB remains unknown.
AIM
The aim of the study was to assess the feasibility, effectiveness, and safety of CCB in patients with HF and cardiac im-plantable electronic devices (CIEDs), the impact of the procedure on symptoms, and echocardiographic parameters.
METHODS
Thirty consecutive HF patients with left ventricular ejection fraction (LVEF) ≤ 40% and CIED, referred for CCB of AF, were included. Procedural parameters were compared to a group of 59 consecutive patients without cardiac diseases referred for CCB (control group).
RESULTS
The number of veins ablated per patient was smaller and application was performed less frequently in the right inferior pulmonary vein in the HF group compared with the control group (66.7% vs. 88.1%; p = 0.01, respectively). In two (6.7%) patients from the HF group and in five (8.5%) from the control group procedure-related complications occurred (p = 0.76). After six months 21 HF patients (70%), after one year 13 (43%), and after 625 days only three (10%) were free from arrhythmia. AF burden was significantly reduced after six months compared to the pre-ablation period (18.5% vs. 52.9%; p = 0.001). New York Heart Association and European Heart Rhythm Association classes were both significantly (p < 0.001) reduced and LVEF was higher after six months in the HF patients.
CONCLUSIONS
Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally nor-mal heart; however, stable positioning of the balloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices.
背景
冷冻球囊导管消融（CCB）进行肺静脉隔离是治疗心房颤动（AF）患者的有效方法，但在心力衰竭（HF）患者中，CCB 的作用尚不清楚。
目的
本研究旨在评估 CCB 在 HF 合并心脏植入电子设备（CIED）患者中的可行性、有效性和安全性，评估该操作对症状和超声心动图参数的影响。
方法
连续纳入 30 例左心室射血分数（LVEF）≤40%且合并 CIED 的 HF 患者，这些患者因 AF 行 CCB。将这些患者的手术参数与 59 例无心脏疾病且行 CCB 的连续患者（对照组）进行比较。
结果
HF 组中每位患者消融的静脉数量较少，且右肺下静脉的应用频率也较低（66.7%比 88.1%；p = 0.01）。HF 组中有 2 例（6.7%）患者和对照组中有 5 例（8.5%）患者发生了与操作相关的并发症（p = 0.76）。HF 组中 21 例（70%）患者在 6 个月时、13 例（43%）患者在 1 年后、仅 3 例（10%）患者在 625 天后无心律失常。与消融前相比，HF 组在 6 个月时的 AF 负荷明显降低（18.5%比 52.9%；p = 0.001）。HF 患者在 6 个月时的纽约心脏协会和欧洲心律协会分级均明显降低（p<0.001），LVEF 也更高。
结论
在 HF 合并 CIED 的患者中，CCB 治疗 AF 的安全性和可行性与结构正常心脏的患者相当；然而，在右肺下静脉中球囊的稳定定位可能更具挑战性。尽管晚期复发较为常见，但消融可降低心律失常负荷，并带来长期的症状和超声心动图指标改善。
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