Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium.
Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM Cotignola, Barbiano, Italy.
J Cardiovasc Med (Hagerstown). 2018 Jun;19(6):290-296. doi: 10.2459/JCM.0000000000000646.
Pulmonary vein stenosis (PVS) is a well recognized complication as a consequence of pulmonary vein isolation. In the current study, we sought to analyze potential anatomical and intraprocedural predictors of PVS during second-generation cryoballoon ablation, particularly focusing on the impact of freeze duration and number of cryoapplications.
Fifty-four patients who underwent cryoballoon ablation for atrial fibrillation were included retrospectively in this study. All patients underwent cardiac-enhanced multidetector computed tomography both before and after the ablation. The exclusion criteria were any contraindications for the procedure, including the presence of an intracavitary thrombus, uncontrolled heart failure and contraindications to general anesthesia.
Mild (25-50%) PVS was only detected in one vein (0.4%) and neither moderate (50-75%) nor severe (>75%) PVS were found. Twenty-five pulmonary veins (12%) exhibited slight narrowing of the diameter (less than 25%). In the univariate analysis, a longer duration of cryoapplication and a larger pulmonary vein ostium preprocedure diameter and area were independently associated with pulmonary vein narrowing [odds ratio (OR): 1.004; confidence interval (CI): 1.001-1.008, P = 0.016; OR: 1.250, CI: 1.090-1.434, P = 0.001 and OR: 1.006; CI: 1.002-1.011, P = 0.006] respectively.
Longer duration of cryoablation, an increased number of applications per vein and larger pulmonary vein ostia are associated with a higher risk of pulmonary vein diameter and area reduction. These findings might suggest to lower the dosing to a single and shorter application if isolation is attained, to reduce the possibility of future pulmonary vein narrowing.
肺静脉狭窄（PVS）是肺静脉隔离后的一种公认并发症。在本研究中，我们旨在分析第二代冷冻球囊消融过程中 PVS 的潜在解剖学和术中预测因素，尤其关注冷冻时间和冷冻球囊应用数量的影响。
回顾性纳入 54 例行冷冻球囊消融治疗房颤的患者。所有患者均在消融前后进行心脏增强多排螺旋 CT 检查。排除标准为存在腔内血栓、未控制的心衰和全麻禁忌等任何操作禁忌。
仅在一条静脉（0.4%）中发现轻度（25-50%）PVS，未发现中度（50-75%）或重度（>75%）PVS。25 条肺静脉（12%）表现为直径轻微狭窄（小于 25%）。单因素分析显示，冷冻球囊应用时间较长、术前肺静脉口直径和面积较大与肺静脉狭窄独立相关[比值比（OR）：1.004；95%置信区间（CI）：1.001-1.008，P=0.016；OR：1.250，95%CI：1.090-1.434，P=0.001 和 OR：1.006；95%CI：1.002-1.011，P=0.006]。
冷冻球囊消融时间较长、每条静脉应用次数增加和肺静脉口较大与肺静脉直径和面积减小的风险增加相关。如果实现了隔离，这些发现可能提示减少单次应用的剂量和应用时间，以降低未来发生肺静脉狭窄的可能性。
