University Heart Center Luebeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany; Usak University, Faculty of Medicine, Department of Cardiology, Usak, Turkey.
University Heart Center Luebeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany.
Int J Cardiol. 2018 Dec 1;272:142-148. doi: 10.1016/j.ijcard.2018.07.033. Epub 2018 Jul 9.
Second generation cryoballoon (CB) has been shown to be effective for treatment of paroxysmal and persistent atrial fibrillation (AF). However, the fixed size of the non-compliant balloon may limit its use in patients with pulmonary vein (PV) abnormalities. In this study we investigated the acute success, procedural complications and long term outcome of CB based PV isolation (PVI) in patients with PV abnormality. A total of 238 patients [64.8 ± 11.1 years; 91 paroxysmal (38.2%), 147 persistent AF (61.8%)] underwent PVI using the second generation CB without preprocedural imaging. In 43/238 (18.1%) patients PV abnormality (left common PV in 26, right middle PV in 20) was observed. All targeted veins including abnormal PVs were isolated (100%). Transient phrenic nerve palsy (PNP) occurred in one (2.3%) patient in the PV anomalous group and 6 (3.0%) in the control group (p = NS). There was no other adverse event including PV stenosis, atrio-esophageal fistula or cerebrovascular events related to the procedure. During mean follow-up of 11.8 ± 5.4 month a total of 59 patients (24.7%) had atrial tachyarrhythmia (ATA) recurrence [27 (11.3%) had AT recurrence]. In the PV anomalous group, 20/43 (46.5%) patients had ATA recurrence compared to 39/195 (20%) in the control group (p < 0.001). AT recurrence was observed in 27 (11.3) patients [11 (25.5%) in the PV anomalous group and 16 (8.2%) in controls respectively, p = 0.003]. In patients with PV abnormality CB-based AF ablation results in a similar acute PVI rate but a higher ATA recurrence rate during follow up as compared to patients without PV abnormality.
第二代冷冻球囊（CB）已被证明对治疗阵发性和持续性心房颤动（AF）有效。然而，非顺应性球囊的固定尺寸可能限制了其在肺静脉（PV）异常患者中的应用。在这项研究中，我们研究了在 PV 异常患者中使用第二代 CB 进行 PV 隔离（PVI）的急性成功率、程序并发症和长期结果。共有 238 名患者[64.8±11.1岁；阵发性 AF 91 例（38.2%），持续性 AF 147 例（61.8%）]在无术前影像学检查的情况下使用第二代 CB 进行 PVI。在 238 例患者中，有 43 例（18.1%）观察到 PV 异常（左总 PV26 例，右中 PV20 例）。所有目标静脉（包括异常 PV）均被隔离（100%）。在 PV 异常组中，1 例（2.3%）患者出现短暂性膈神经麻痹（PNP），对照组 6 例（3.0%）（p=NS）。没有其他与程序相关的不良事件，包括 PV 狭窄、食管-心脏瘘或脑血管事件。在平均 11.8±5.4 个月的随访中，共有 59 例患者（24.7%）出现房性快速性心律失常（ATA）复发[27 例（11.3%）发生 AT 复发]。在 PV 异常组中，43 例中有 20 例（46.5%）发生 ATA 复发，而对照组 195 例中有 39 例（20%）（p<0.001）。在 PV 异常组中，有 27 例（11.3%）患者发生 AT 复发[25.5%（11 例）和 8.2%（16 例）分别在 PV 异常组和对照组中，p=0.003]。在 PV 异常患者中，与无 PV 异常患者相比，CB 消融治疗房颤的急性 PVI 成功率相似，但在随访期间 ATA 复发率较高。
