Cardio-angiological Center Bethanien, Agaplesion Markus Hospital, Medical Clinic III.
Department of Cardiology, International Medical Center, Saitama Medical University.
Circ J. 2018 May 25;82(6):1558-1565. doi: 10.1253/circj.CJ-17-1324. Epub 2018 Apr 5.
The incidence of pulmonary vein stenosis (PVS) after AF ablation following contemporary procedures remains unclear. We compared the incidence of PVS/narrowing (PVS/N) after PV isolation (PVI) for (1) 3-D mapping-guided wide-area encircling irrigated radiofrequency current (RFC) ablation; (2) first-third-generation big cryoballoon (CB1-3) ablation; and (3) laser balloon (LB) ablation.
All patients undergoing a second procedure between January 2012 and November 2016 were subgrouped according to index ablation (PVI): RFC; CB; or LB. PVS/N was classified using PV diameter ratio (second/index procedure) on selective PV angiogram performed before ablation: mild, 25-49%; moderate, 50-74%; or severe, ≥75%. A total of 344 patients (1,362 PV) were analyzed (RFC, n=211; 840 PV; CB1, n=21; 82 PV; CB2,3, n=64; 250 PV; LB, n=48; 190 PV). In the LB group, 45 patients (94%) were treated with dose ≥8.5 W. Second procedures were performed on average 14.9±14.1 months after the index procedure. Mild PVS/N was observed in 18.4%, 9.5% and 3.6% of PV in the LB, RFC and CB groups, respectively (P<0.01). Moderate PVS was recognized in 2 PV (0.1%; RFC, LB). Severe PVS was never observed, and no PV intervention/surgery was required.
The risk for significant PVS is low after RFC/CB. The incidence of mild PVS/N was highest after standard-dose LB ablation and lowest after high-dose CB ablation.
在当代程序下，AF 消融后肺静脉狭窄（PVS）的发生率尚不清楚。我们比较了 3-维标测指导下大面积环行灌流射频（RFC）消融、第一代至第三代大冷冻球囊（CB1-3）消融和激光球囊（LB）消融后肺静脉隔离（PVI）后 PVS/狭窄（PVS/N）的发生率。
所有在 2012 年 1 月至 2016 年 11 月间行二次介入治疗的患者，根据索引消融（PVI）分为 RFC、CB 或 LB 亚组。PVS/N 通过消融前选择性肺静脉造影测量的肺静脉直径比（第二次/索引手术）进行分类：轻度，25%-49%；中度，50%-74%；或重度，≥75%。共分析 344 例（1362 条肺静脉）患者（RFC，n=211；840 条肺静脉；CB1，n=21；82 条肺静脉；CB2，3，n=64；250 条肺静脉；LB，n=48；190 条肺静脉）。LB 组中 45 例（94%）患者接受的功率≥8.5 W。二次手术平均在索引手术后 14.9±14.1 个月进行。LB、RFC 和 CB 组中轻度 PVS/N 的肺静脉分别为 18.4%、9.5%和 3.6%（P<0.01）。2 条肺静脉（0.1%；RFC，LB）中发现中度 PVS。未见重度 PVS，也无需行肺静脉介入/手术。
RFC/CB 后 PVS 发生率较低。标准剂量 LB 消融后轻度 PVS/N 发生率最高，高剂量 CB 消融后发生率最低。
