Gramlich Michael, Maleck Carole, Marquardt Jonathan, Duckheim Martin, Stimpfle Fabian, Heinzmann David, Scheckenbach Christian, Gawaz Meinrad, Schreieck Jürgen, Seizer Peter
Department of Invasive Electrophysiology, RWTH Aachen, Aachen, Germany.
Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany.
J Cardiovasc Electrophysiol. 2019 Jul;30(7):999-1004. doi: 10.1111/jce.13936. Epub 2019 Apr 11.
The role of cryoballoon (CB) pulmonary vein isolation (PVI) for patients with persistent atrial fibrillation (AF) is controversial, since long-term success can be poor. We performed left atrial voltage mapping before CB PVI and determined AF-free survival depending on the extent of low-voltage areas (LVAs).
We consecutively enrolled 60 patients with persistent AF (average age, 60.6 ± 12.9 years; CHA DS VASc score, 2.3 ± 1.6; and left atrial size 46.0 ± 5.2 mm) who were planned for CB PVI. Before ablation, we performed left atrial voltage mapping (Abbott EnSite Precision or Velocity). LVAs were defined if local bipolar signal amplitudes were less than 0.5 mV during sinus rhythm. Thirty-seven patients did not show significant LVAs (<10%), while 12 patients had LVAs between 10% and 30% and 11 patients showed substantial LVAs greater than 30% of the left atrial area. CB PVI could be successfully performed in all patients. A 7-day holter monitoring was obtained 3, 6, and 12 months after ablation. After a 12-month follow-up time, 83.8% of patients without LVAs (<10%) were free of atrial fibrillation, while 50.0% of patients with 10% to 30% LVAs and 9.1% of patients with LVAs more than 30% had stable sinus rhythm. The degree of atrial fibrosis correlated with the risk of AF recurrence.
In patients with persistent AF undergoing CB PVI, the extent of left atrial LVAs predicts an AF-free survival. CB PVI seems to be a highly effective treatment for patients with persistent AF without atrial fibrosis.
冷冻球囊（CB）肺静脉隔离术（PVI）在持续性心房颤动（AF）患者中的作用存在争议，因为长期成功率可能较低。我们在CB PVI术前进行了左心房电压标测，并根据低电压区（LVA）范围确定无房颤生存期。
我们连续纳入60例计划行CB PVI的持续性AF患者（平均年龄60.6±12.9岁；CHA₂DS₂-VASc评分2.3±1.6；左心房大小46.0±5.2mm）。消融术前，我们进行了左心房电压标测（雅培EnSite Precision或Velocity）。窦性心律时，若局部双极信号振幅小于0.5mV，则定义为LVA。37例患者未显示明显LVA（<10%），12例患者LVA在10%至30%之间，11例患者显示LVA大于左心房面积的30%。所有患者均成功进行了CB PVI。消融术后3、6和12个月进行了7天动态心电图监测。随访12个月后，无LVA（<10%）患者中83.8%无房颤，LVA为10%至30%的患者中50.0%和LVA大于30%的患者中9.1%有稳定的窦性心律。心房纤维化程度与房颤复发风险相关。
在接受CB PVI的持续性AF患者中，左心房LVA范围可预测无房颤生存期。CB PVI似乎是治疗无心房纤维化的持续性AF患者的高效方法。
