使用28毫米冷冻球囊进行肺静脉隔离急性期时左心房大小对隔离区域的影响

Impact of left atrial size on isolation area in the acute phase of pulmonary vein isolation using 28 mm cryoballoon.

作者信息

Chikata Akio, Kato Takeshi, Usuda Kazuo, Fujita Shuhei, Maruyama Michiro, Nagata Yoshiki, Sakagami Satoru, Kanamori Naomi, Yaegashi Takanori, Saeki Takahiro, Kusayama Takashi, Usui Soichiro, Furusho Hiroshi, Kaneko Shuichi, Takamura Masayuki

机构信息

Division of Cardiology, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan.

Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.

出版信息

Pacing Clin Electrophysiol. 2018 Jul;41(7):700-706. doi: 10.1111/pace.13337. Epub 2018 May 8.

DOI:10.1111/pace.13337

PMID:29603755

Abstract

BACKGROUND

The impact of left atrial (LA) size on isolation area (ISA) using a 28-mm second-generation cryoballoon (CB) in the acute phase after pulmonary vein isolation (PVI) and the differences of CB from contact force-guided radiofrequency (RF) ablation have not been fully investigated.

METHODS

We examined 85 consecutive patients (CB group, 35; RF group, 50) with drug-refractory paroxysmal atrial fibrillation who underwent their first PVI procedure at two institutions. We evaluated ISA after PVI using 3D-Merge computed tomography images (GE Healthcare, Little Chalfont, UK) and high-resolution electroanatomical mapping.

RESULTS

Total ISA was significantly smaller in the CB group (20.6 ± 6.0 cm ) than in the RF group (29.0 ± 7.1 cm ; P < 0.0001). In the CB group, ISA of the left pulmonary vein (LPV), right pulmonary vein (RPV), and total ISA were not correlated with the left atrial surface area (LASA). The ratios of ISA to LASA (%ISA) of LPV and total ISA negatively correlated with LASA in the CB group (LPV: r = -0.4001, P = 0.0173; total ISA: r = -0.4733, P = 0.0041). In contrast, in the RF group, ISA of LPV, RPV, and total ISA positively correlated with LASA; (LPV: r = 0.5155, P = 0.001; RPV: r = 0.6398, P < 0.0001; total ISA: r = 0.7299, P < 0.0001).

CONCLUSION

ISA created using CB was significantly smaller than that using RF and did not change regardless of LASA increment. Differences in ISA between the two groups became more prominent in the large atrium.

摘要

背景

在肺静脉隔离（PVI）急性期使用28毫米第二代冷冻球囊（CB）时，左心房（LA）大小对隔离区域（ISA）的影响以及CB与接触力引导下射频（RF）消融的差异尚未得到充分研究。

方法

我们检查了85例连续的药物难治性阵发性房颤患者（CB组35例；RF组50例），这些患者在两家机构接受了首次PVI手术。我们使用3D-Merge计算机断层扫描图像（GE Healthcare，英国小查尔方特）和高分辨率电解剖标测评估PVI后的ISA。

结果

CB组的总ISA（20.6±6.0平方厘米）明显小于RF组（29.0±7.1平方厘米；P<0.0001）。在CB组中，左肺静脉（LPV）、右肺静脉（RPV）的ISA和总ISA与左心房表面积（LASA）无关。CB组中LPV和总ISA的ISA与LASA之比（%ISA）与LASA呈负相关（LPV：r=-0.4001，P=0.0173；总ISA：r=-0.4733，P=0.0041）。相比之下，在RF组中，LPV、RPV的ISA和总ISA与LASA呈正相关；（LPV：r=0.5155，P=0.001；RPV：r=0.6398，P<0.0001；总ISA：r=0.7299，P<0.0001）。