Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cardiovasc Electrophysiol. 2020 Jun;31(6):1307-1314. doi: 10.1111/jce.14477. Epub 2020 Apr 11.
The safety and efficacy of superior vena cava (SVC) isolation using second-generation cryoballoon (CB) ablation remain unknown.
A total of 26 (3.2%) patients with SVC-related paroxysmal atrial fibrillation (AF) from a consecutive series of 806 patients who underwent second-generation CB were included. Pulmonary vein isolation was initially achieved by CB ablation. If the SVC trigger was determined, the electrical isolation of SVC isolation was performed using the second-generation CB.
Real-time SVC potential was observed in all patients. Isolation of the SVC was successfully accomplished in 21 (80.8%) patients. The mean number of freeze cycles in each patient was 2.1 ± 1.1. The mean time to isolation and ablation duration were 22.5 ± 14.2 seconds and 94.5 ± 22.3 seconds, respectively. A transient phrenic nerve (PN) injury was observed in five patients (19.2%). There were two patients (7.7%) experienced reversible sinus node injury during the first application. During a mean follow-up period of 13.2 ± 5.8 months, four patients (15.4%) had atrial arrhythmia recurrences.
Isolation of SVC using the second-generation 28-mm CB is feasible when SVC driver during AF is identified. Vigilant monitoring of PN function during CB ablation of SVC is needed to avoid PN injury.
使用第二代冷冻球囊（CB）消融治疗上腔静脉（SVC）的安全性和有效性尚不清楚。
共纳入 806 例连续接受第二代 CB 治疗的阵发性房颤患者中 26 例（3.2%）存在 SVC 相关的阵发性房颤。首先通过 CB 消融实现肺静脉隔离。如果确定 SVC 触发，则使用第二代 CB 进行 SVC 电隔离。
所有患者均观察到实时 SVC 电位。21 例（80.8%）患者成功完成 SVC 隔离。每位患者的冷冻循环平均次数为 2.1±1.1。隔离和消融的平均时间分别为 22.5±14.2 秒和 94.5±22.3 秒。5 例患者（19.2%）出现一过性膈神经（PN）损伤。有 2 例患者（7.7%）在第一次应用时出现可逆性窦房结损伤。在平均 13.2±5.8 个月的随访期间，4 例患者（15.4%）出现房性心律失常复发。
当识别到房颤期间的 SVC 驱动时，使用第二代 28mm CB 隔离 SVC 是可行的。在 SVC 的 CB 消融过程中需要警惕监测 PN 功能，以避免 PN 损伤。
