左肺总静脉情况下射频消融与冷冻球囊消融治疗心房颤动的比较
Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins.
作者信息
Coutiño Hugo-Enrique, Ströker Erwin, Takarada Ken, Mugnai Giacomo, Abugattas Juan-Pablo, Sieira Juan, Salghetti Francesca, Terasawa Muryo, Varnavas Varnavas, Maj Riccardo, Osório Thiago Guimarães, Neach Diego, Brugada Pedro, de Asmundis Carlo, Chierchia Gian-Battista
机构信息
Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium.
出版信息
Pacing Clin Electrophysiol. 2019 Nov;42(11):1456-1462. doi: 10.1111/pace.13810. Epub 2019 Oct 10.
BACKGROUND
A left common pulmonary vein (LCPV) accounts as the most frequent pulmonary vein (PV) variation. Our aim was to compare the performance of radiofrequency (RF) versus second-generation cryoballoon (CB-A) ablation in patients with atrial fibrillation (AF) and LCPVs.
METHODS
In a total cohort of 716 patients undergoing PV isolation with preprocedural CT-scanning, LCPV+ patients were selected with measurement of PV ostial area and trunk distance. All LCPV+ patients were matched between RF and CB-A group in a 1:1 ratio based on propensity scores, and compared for outcome.
RESULTS
Left common pulmonary veins were found in 31% (88/283) RF versus 34% (146/433) CB-A patients, respectively, (P = .44). In the matched population of 83 LCPV+ patients in each group, electrical isolation could be achieved in all left-sided PVs. No significant difference was noted for the rate of AF/left atrial tachyarrhythmia (LAT) recurrence between RF and CB-A group (30% vs 28%, P = .86), with similar AF/LAT-free survival (log rank, P = .71). There were 48 patients with AF/LAT recurrence (29%) during the follow-up. Recurrence rate between paroxysmal versus persistent AF was 27/120 (22.5%) versus 21/46 (46%), P = .004. Cox proportional regression analysis withheld LA volume and persistent AF as independent variables to predict AF/LAT recurrence. No increased hazard for AF/LAT recurrence was observed for patients with a long (>15 mm) vs short (5-15 mm) LCPV trunk (OR 1.14, 95% CI 0.6-2.2, P = .7).
CONCLUSIONS
In our study, equal efficacy and outcome was noted in LCPV+ patients between RF and CB-A technology.
背景
左肺静脉是最常见的肺静脉变异类型。我们的目的是比较射频消融（RF）与第二代冷冻球囊消融（CB-A）治疗心房颤动（AF）合并左肺静脉（LCPV）患者的疗效。
方法
在716例行肺静脉隔离术且术前进行CT扫描的患者队列中，选择LCPV+患者并测量肺静脉开口面积和主干长度。所有LCPV+患者根据倾向得分按1:1比例在RF组和CB-A组之间进行匹配，并比较治疗结果。
结果
RF组和CB-A组分别有31%（88/283）和34%（146/433）的患者发现左肺静脉（P = 0.44）。在每组83例LCPV+患者的匹配人群中，所有左侧肺静脉均能实现电隔离。RF组和CB-A组之间AF/左房性心动过速（LAT）复发率无显著差异（30%对28%，P = 0.86），无AF/LAT生存情况相似（对数秩检验，P = 0.71）。随访期间有48例患者发生AF/LAT复发（29%）。阵发性AF与持续性AF的复发率分别为27/120（22.5%）和21/46（46%），P = 0.004。Cox比例回归分析将左房容积和持续性AF作为独立变量来预测AF/LAT复发。LCPV主干长（>15 mm）与短（5 - 15 mm）的患者AF/LAT复发风险未增加（OR 1.14，95% CI 0.6 - 2.2，P = 0.7）。
结论
在我们的研究中，RF和CB-A技术治疗LCPV+患者的疗效和结果相当。
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