Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama City, Saitama Prefecture, Japan.
Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama City, Saitama Prefecture, Japan.
Heart Rhythm. 2019 Jun;16(6):838-845. doi: 10.1016/j.hrthm.2018.12.019. Epub 2018 Dec 18.
Pulmonary vein isolation (PVI) with a cryoballoon (CB) is an effective treatment for atrial fibrillation (AF). The efficacy of CB PVI for elderly patients with AF remains unclear.
We aimed to analyze the clinical outcomes of CB ablation compared with radiofrequency (RF) ablation in elderly patients with AF.
This was a single-center retrospective study of 305 patients older than 75 years with paroxysmal and persistent AF who underwent PVI between January 2012 and August 2017. Patients were matched according to propensity scores in a logistic regression model. The end point of this study was AF/atrial tachycardia recurrence at 12-month follow-up.
In total, 198 patients (99 matched pairs) were analyzed. The ratio of paroxysmal AF was 83%, and the mean age was 78 ± 2 years. The mean procedure time was significantly lower in the CB group (134 ± 62 minutes vs 190 ± 51 minutes; P < .001). There was no significant difference between the groups in terms of success rate at 12 months after the procedure (CB 80.5% vs RF 79.4%; P = .72) or incidence of complications (CB 12% vs RF 16%; P = .80). Kaplan-Meier estimates revealed no significant difference between clinical outcomes after PVI with a CB or RF for elderly patients with non-pulmonary vein foci that were all successfully ablated (CB 68.8% vs RF 68.4% at 12 months; P = .835).
The efficacy of PVI with a CB might be comparable to that of PVI with RF in AF patients older than 75 years and involve a shorter procedure time.
冷冻球囊（CB）肺静脉隔离（PVI）是治疗心房颤动（AF）的有效方法。CB PVI 治疗老年 AF 患者的疗效尚不清楚。
我们旨在分析 CB 消融与射频（RF）消融治疗老年 AF 患者的临床疗效。
这是一项回顾性单中心研究，纳入了 2012 年 1 月至 2017 年 8 月间接受 PVI 的 305 例年龄大于 75 岁的阵发性和持续性 AF 患者。根据逻辑回归模型中的倾向评分对患者进行匹配。本研究的终点为 12 个月随访时 AF/房性心动过速的复发情况。
共分析了 198 例患者（99 对匹配）。阵发性 AF 比例为 83%，平均年龄为 78±2 岁。CB 组的平均手术时间明显短于 RF 组（134±62 分钟比 190±51 分钟；P<0.001）。两组术后 12 个月的成功率（CB 组 80.5%，RF 组 79.4%；P=0.72）或并发症发生率（CB 组 12%，RF 组 16%；P=0.80）均无显著差异。Kaplan-Meier 估计显示，对于所有成功消融的非肺静脉病灶的老年患者，CB 或 RF 行 PVI 后的临床结果无显著差异（CB 组 12 个月时为 68.8%，RF 组为 68.4%；P=0.835）。
对于年龄大于 75 岁的 AF 患者，CB 行 PVI 的疗效可能与 RF 行 PVI 相当，且手术时间更短。
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