Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA.
Division of Cardiology, University of Belgrade, Beograd, Serbia.
J Interv Card Electrophysiol. 2020 Aug;58(2):209-217. doi: 10.1007/s10840-019-00588-x. Epub 2019 Jul 20.
Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA.
Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables.
Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0%) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7%) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73.
SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.
冷冻球囊消融（CBA）是肺静脉隔离（PVI）的有效技术。迄今为止，尚无预测 CBA 后非常晚期心房颤动（VLRAF）复发的风险模型。
对单中心数据库进行回顾性分析。纳入标准包括使用 CBA 进行无附加消融靶点的房颤（AF）的 PVI、随访时间>365 天且术后 90 至 365 天之间无 AF 复发。主要终点是 CBA 后>30 秒>12 个月的复发性 AF。使用临床变量创建风险模型。
在 2011 年至 2016 年间进行的 674 次 CBA 中，有 300 例患者（200 例男性，62.0±9.9 岁）符合纳入标准。其中，159 例（53.0%）患者为阵发性 AF。患者平均进行 9.5±2.7 次冷冻球囊冷冻，无患者需要额外的射频消融治疗。在 995±490 天的随访中，300 例患者中有 77 例（25.7%）出现 VLRAF。单因素和多因素分析表明，结构性心脏病（1 分）、冠心病（3 分）、左心房直径>43mm（1 分）、左束支传导阻滞（3 分）、AF 早期恢复（4 分）和非阵发性 AF（3 分）是 VLRAF 的危险因素。将这些变量组合成一个风险模型，SCALE-CryoAF（最小 0；最大 15）预测 CBA 后 VLRAF 的曲线下面积为 0.73。
SCALE-CryoAF 是第一个专门预测 CBA 后 1 年以上、VLRAF 的 AF 复发风险模型。模型鉴别力表明，SCALE-CryoAF 预测 CBA 后 VLRAF 的效果明显优于其他 AF 复发风险模型。
