Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.
Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan.
J Cardiovasc Electrophysiol. 2020 Apr;31(4):875-884. doi: 10.1111/jce.14379. Epub 2020 Feb 10.
Pulmonary vein isolation (PVI) and linear ablation with a roof line and bottom line on the left atrial (LA) posterior wall (LAPW) can be achieved with a cryoballoon (CB). This study sought to investigate the long-term durability of these linear lesions.
Among 290 persistent patients with atrial fibrillation (AF) who had undergone linear ablation with a CB on the roof and bottom line of the LAPW in addition to the PVI, we analyzed those patients who underwent a re-do AF ablation. Arrhythmia recurrence was confirmed in 70 (24%) out of 290 patients, and 47 (16%) patients underwent re-do sessions. At the beginning of the re-do ablation, we examined the reconnection sites of the linear lesions on the LAPW and PVI. Maintenance of the conduction block on the LAPW roof and bottom lines was observed in 35 out of 47 patients (74.5%), and 16 out of 35 patients (45.7%), respectively. The length of the roof line was significantly shorter in patients with preservation of the conduction block on the LAPW roof than in those without (36.2 ± 6.5 mm vs 41.6 ± 4.7 mm, P = .02).
Durable lesions could be obtained after linear ablation with the CB for the LAPW roof line, especially in those with a relatively short LAPW roof line. However, patients requiring touch-up ablation with radiofrequency were included, and that was associated with a potential financial implication.
肺静脉隔离 (PVI) 和左心房 (LA) 后侧壁 (LAPW) 上的线消融与房顶线和底线可以通过使用冷冻球囊 (CB) 来实现。本研究旨在调查这些线性消融线的长期耐久性。
在 290 例持续性房颤 (AF) 患者中，除 PVI 外，还在 LAPW 的房顶线和底线处使用 CB 进行线性消融，我们分析了这些患者中进行重复 AF 消融的患者。在 290 例患者中，有 70 例（24%）发生心律失常复发，47 例（16%）患者进行了重复治疗。在重复消融开始时，我们检查了 LAPW 和 PVI 上线性消融线的再连接部位。在 47 例患者中的 35 例（74.5%）观察到 LAPW 房顶和底线的传导阻滞得到维持，在这 35 例患者中的 16 例（45.7%）中分别观察到维持。与未保留 LAPW 房顶线传导阻滞的患者相比，保留 LAPW 房顶线传导阻滞的患者的房顶线长度明显更短（36.2 ± 6.5mm 比 41.6 ± 4.7mm，P=0.02）。
使用 CB 进行 LAPW 房顶线的线性消融可以获得持久的消融线，尤其是在 LAPW 房顶线相对较短的患者中。然而，本研究纳入了需要射频触诊消融的患者，这可能会带来潜在的经济影响。
