Sunaga Akihiro, Masuda Masaharu, Asai Mitsutoshi, Iida Osamu, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Kanda Takashi, Tsujimura Takuya, Matsuda Yasuhiro, Okuno Syota, Mano Toshiaki
Kansai Rosai Hospital Cardiovascular Center, 3-1-69, Inabaso, Amagasakishi, Hyogo, 660-8511, Japan.
J Interv Card Electrophysiol. 2018 Oct;53(1):115-121. doi: 10.1007/s10840-018-0366-7. Epub 2018 Apr 10.
Pulmonary venography is routinely used to confirm pulmonary vein (PV) occlusion during cryoballoon ablation. However, this technique is significantly limited by the risks associated with contrast media, such as renal injury and contrast allergy. We hypothesized that PV occlusion can be predicted by elevation of the balloon catheter tip pressure, avoiding the need for contrast media.
Forty-eight consecutive patients with paroxysmal atrial fibrillation who underwent PV isolation with the cryoballoon technique were enrolled. The balloon catheter tip pressure was measured in each PV before and after balloon inflation.
We analyzed 200 applications of cryoballoon ablation in 185 PVs (excluding 3 common PVs and 1 extremely small right inferior PV) of 48 patients (age, 70 ± 11 years; male, n = 28; mean left atrial diameter, 38 ± 6 mm). Compared with patients with unsuccessful occlusion, patients with successful occlusion demonstrated a larger change in pressure after balloon inflation (6 ± 8 vs. 2 ± 4 mmHg, P < 0.001), a lower minimum temperature (- 49 ± 6 vs. - 40 ± 8 °C, P < 0.001), and a higher PV isolation rate (97 vs. 64%, P < 0.001). The best cutoff value of a change in pressure for predicting PV occlusion was 4.5 mmHg, with a sensitivity of 67%, specificity of 83%, and predictive accuracy of 72%.
Pressure monitoring is helpful to confirm PV occlusion during cryoballoon ablation.
在冷冻球囊消融术中，肺静脉造影常用于确认肺静脉（PV）闭塞情况。然而，该技术受到造影剂相关风险的显著限制，如肾损伤和造影剂过敏。我们推测通过球囊导管尖端压力升高可预测PV闭塞，从而无需使用造影剂。
连续纳入48例接受冷冻球囊技术进行肺静脉隔离的阵发性房颤患者。在球囊充气前后测量每个PV的球囊导管尖端压力。
我们分析了48例患者（年龄70±11岁；男性28例；平均左心房直径38±6mm）185个PV（不包括3个共同PV和1个极小的右下PV）的200次冷冻球囊消融应用情况。与闭塞未成功的患者相比，闭塞成功的患者球囊充气后压力变化更大（6±8 vs. 2±4mmHg，P<0.001），最低温度更低（-49±6 vs. -40±8°C，P<0.001），PV隔离率更高（97% vs. 64%，P<0.001）。预测PV闭塞的压力变化最佳截断值为4.5mmHg，敏感性为67%，特异性为83%，预测准确率为72%。
压力监测有助于在冷冻球囊消融术中确认PV闭塞。
