University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck.
Circ J. 2020 May 25;84(6):902-910. doi: 10.1253/circj.CJ-19-1144. Epub 2020 Apr 18.
The second-generation cryoballoon (CB2) has demonstrated high procedural efficacy and convincing clinical success rates for pulmonary vein isolation (PVI). Nevertheless, data on the impact of different ablations protocols on durability are limited. The aim was to comparing the durability of PVI following 3 different ablation strategies in patients with recurrence of atrial fibrillation or atrial tachycardia undergoing repeat procedures.
In 192 patients, a total of 751 PVs were identified. All PVs were successfully isolated during index PVI. Thirty-one out of 192 (16%) patients were treated with a bonus-freeze protocol (group 1), 67/192 (35%) patients with a no bonus-freeze protocol (group 2), and 94/192 (49%) patients with a time-to-effect-guided protocol (group 3). Persistent PVI was documented in 419/751 (55.8%) PVs, and in 41/192 (21%) patients, all PVs were persistently isolated. The total rate of PV reconnection was not significantly different between the groups (P=0.134) and the comparison of individual PVs revealed no differences (P-values for RSPV: 0.424, RIPV: 0.541, LSPV: 0.788, LIPV: 0.346, LCPV: 0.865). The procedure times were significantly reduced by omitting the bonus-freeze and applying individualized application times (group 1: 123.4±31.5 min, group 2: 112.9±39.8 min, group 3: 86.67±28.4 min, P<0.001).
Comparing 3 common ablation protocols, no differences for durable PVI were detected. Procedure times were significantly reduced by omitting the bonus-freeze cycle and by applying individualized application times.
第二代冷冻球囊（CB2）在肺静脉隔离（PVI）方面已显示出较高的程序疗效和令人信服的临床成功率。然而，关于不同消融方案对持久性影响的数据有限。本研究旨在比较在因房颤或房性心动过速复发而再次行导管消融的患者中，三种不同消融策略对持久性 PVI 的影响。
在 192 名患者中，共确定了 751 条肺静脉。所有肺静脉在首次 PVI 中均成功隔离。192 名患者中有 31 名（16%）采用无补冻策略（组 1），67 名（35%）采用无补冻策略（组 2），94 名（49%）采用时间控制策略（组 3）。751 条肺静脉中有 419 条（55.8%）存在持续性 PVI，192 名患者中有 41 名（21%）所有肺静脉均持续隔离。三组间的 PV 再连接总发生率无显著差异（P=0.134），对单个 PV 的比较也未发现差异（RSPV：P 值为 0.424，RIPV：P 值为 0.541，LSPV：P 值为 0.788，LIPV：P 值为 0.346，LCPV：P 值为 0.865）。通过省略补冻和应用个体化应用时间，手术时间显著缩短（组 1：123.4±31.5 min，组 2：112.9±39.8 min，组 3：86.67±28.4 min，P<0.001）。
比较三种常见的消融方案，未发现持久性 PVI 存在差异。通过省略补冻循环和应用个体化应用时间，手术时间显著缩短。
