Iacopino Saverio, Paparella Gaetano, Capulzini Lucio, Ströker Erwin, Beckers Stefan, Osório Thiago Guimarães, Varnavas Varnavas, Sieira Juan, Abugattas Juan Pablo, Maj Riccardo, Salghetti Francesca, Umbrain Vincent, Terasawa Muryo, Brugada Pedro, de Asmundis Carlo, Chierchia Gian Battista
Electrophysiology Unit, Villa Maria Cecilia Hospital, Gruppo Villa Maria, Cotignola, Italy.
Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit, Brussels, Belgium.
J Interv Card Electrophysiol. 2019 Oct;56(1):1-7. doi: 10.1007/s10840-019-00551-w. Epub 2019 Apr 27.
The creation of a posterior box isolation of the left atrium (LAPWI) in addition to pulmonary vein isolation (PVI) with the second-generation cryoballoon (CB-A) seems to offer promising clinical outcome in patients affected by persistent atrial fibrillation (PersAF).
This work aims to study the clinical outcome of an ablation strategy based on the creation of a LAPWI during repeat procedures for recurrent AF after an index CB-A procedure for PersAF.
A total of 33 patients having undergone a repeat procedure consisting in redo PVI plus LAPWI for recurrent PersAF with the CB-A after an index PVI ablation were retrospective included in our study. Electrical reconnection could be documented in 18 veins (13%). The LAPW was successfully isolated solely by CB-A ablation in 30 out of 33 (91%) patients; in the remaining 3 patients, isolation of the LAPW was completed by focal tip-irrigated RF ablation. The mean number of CB-A applications required for the superior portion of the LAPW and the inferior portion of the LAPW creation were 5.4 ± 0.9 and 4 ± 0.6, respectively. After a mean follow-up of 11.8 ± 3 months, 28 patients (85%) did not experience recurrence of any atrial arrhythmias during follow-up, without the need of further ablation or class I or III AADs.
Left posterior wall isolation with the CB-A is feasible and safe during repeat ablation procedures for recurrent PersAF. In our study, the 12-month freedom from any arrhythmia was 85% following this ablation strategy.
除了使用第二代冷冻球囊（CB-A）进行肺静脉隔离（PVI）之外，创建左心房后壁隔离（LAPWI）似乎为持续性心房颤动（PersAF）患者带来了有前景的临床结果。
本研究旨在探讨在首次使用CB-A进行PersAF消融术后复发房颤的再次手术中，基于创建LAPWI的消融策略的临床结果。
我们回顾性纳入了33例患者，这些患者在首次PVI消融术后因复发性PersAF接受了再次手术，包括再次PVI加LAPWI，使用的是CB-A。18条静脉（13%）可记录到电连接恢复。33例患者中有30例（91%）仅通过CB-A消融成功隔离了LAPW；其余3例患者通过局部尖端灌注射频消融完成了LAPW的隔离。创建LAPW上半部分和下半部分所需的CB-A平均应用次数分别为5.4±0.9次和4±0.6次。平均随访11.8±3个月后，28例患者（85%）在随访期间未出现任何房性心律失常复发，无需进一步消融或使用I类或III类抗心律失常药物（AADs）。
在复发性PersAF的再次消融手术中，使用CB-A进行左后壁隔离是可行且安全的。在我们的研究中，采用这种消融策略后，12个月无任何心律失常的比例为85%。
