Guhl Emily N, Smith Benjamin, Lehmann Helge, Adelstein Evan, Bhonsale Aditya, Kancharla Krishna, Voigt Andrew, Wang Norman C, Saba Samir, Jain Sandeep K
Center for Atrial Fibrillation, Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, PUH B-535, Pittsburgh, PA, 15312, USA.
J Interv Card Electrophysiol. 2019 Apr;54(3):225-229. doi: 10.1007/s10840-018-0475-3. Epub 2018 Oct 17.
Cryoballoon pulmonary vein isolation (PVI) is commonly used for rhythm control of atrial fibrillation (AF). Data are limited examining the outcomes of cryoballoon PVI in patients with systolic dysfunction. We evaluate the impact of cryoballoon PVI in patients with systolic dysfunction.
We evaluated a single-center prospective registry of patients undergoing cryoballoon PVI between 8/2011 and 6/2016. Patients with systolic dysfunction (EF < 55%) between the time of AF diagnosis and their cryoballoon PVI procedure were assessed for AF recurrence at 6 months and 1 year post-procedure, with a 3-month blanking period.
Final analysis included 66 patients with systolic dysfunction undergoing cryoballoon PVI. An AF diagnosis for ≥ 1 year prior to PVI was present in 62.1% (n = 41), and 53.0% (n = 35) had systolic dysfunction for ≥ 1 year pre-procedure. The proportion of AF-free patients at 1 year was 51.5%. Of patients with echocardiograms performed at 1 year (n = 43), a greater proportion of individuals without AF recurrence had an improvement in EF of ≥ 10% than in those with AF recurrence (54.2% vs. 25.0%, p = 0.039). Of the patients who had systolic dysfunction at the time of the ablation (EF < 55%), there was a significant increase in EF post-procedure (36.5% pre-procedure vs. 48.3% post-procedure, mean change 11.8%, p < 0.001).
In patients with systolic dysfunction, cryoballoon PVI provides an acceptable AF recurrence-free rate at 1 year. AF recurrence-free individuals were more likely to have improvement in EF. Further evaluation is needed to determine the potential role of early cryoballoon PVI in patients with a new diagnosis of systolic dysfunction and AF.
冷冻球囊肺静脉隔离术（PVI）常用于心房颤动（AF）的节律控制。关于收缩功能障碍患者冷冻球囊PVI治疗结果的数据有限。我们评估冷冻球囊PVI对收缩功能障碍患者的影响。
我们评估了2011年8月至2016年6月期间接受冷冻球囊PVI治疗的患者的单中心前瞻性登记资料。对AF诊断至冷冻球囊PVI手术期间存在收缩功能障碍（左心室射血分数[EF]<55%）的患者，在术后6个月和1年评估AF复发情况，有3个月的空白期。
最终分析纳入了66例接受冷冻球囊PVI治疗的收缩功能障碍患者。62.1%（n=41）的患者在PVI前AF诊断≥1年，53.0%（n=35）的患者在手术前收缩功能障碍≥1年。1年时无AF患者的比例为51.5%。在1年时进行超声心动图检查的患者（n=43）中，无AF复发的个体中EF改善≥10%的比例高于有AF复发的个体（54.2%对25.0%，p=0.039）。在消融时存在收缩功能障碍（EF<55%）的患者中，术后EF有显著增加（术前36.5%对术后48.3%，平均变化11.8%，p<0.001）。
对于收缩功能障碍患者，冷冻球囊PVI在1年时提供了可接受的无AF复发率。无AF复发的个体更有可能出现EF改善。需要进一步评估以确定早期冷冻球囊PVI在新诊断的收缩功能障碍和AF患者中的潜在作用。
