Chen Shaojie, Schmidt Boris, Bordignon Stefano, Tohoku Shota, Urbanek Lukas, Plank Karin, Willems Franziska, Throm Christina, Konstantinou Athanasios, Hilbert Max, Zanchi Simone, Bianchini Lorenzo, Bologna Fabrizio, Tsianakas Nikolaos, Kreuzer Claudia, Nagase Takahiko, Perrotta Laura, Last Jana, Chun K R Julian
Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.
Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany.
J Cardiovasc Electrophysiol. 2020 Aug;31(8):1923-1931. doi: 10.1111/jce.14602. Epub 2020 Jun 18.
Time-to-isolation (TTI) guided second-generation cryoballoon (CB2) ablation has been shown to be effective for pulmonary vein isolation (PVI).
The objective of this paper is to compare the safety and clinical outcome of CB2 PVI using the TTI guided 4 minutes vs 3 minutes freeze protocol.
This was a propensity-matched study based on an institutional database. Symptomatic atrial fibrillation (AF) patients who underwent CB2 PVI and systematic follow-up were consecutively included.
A total of 573 patients were identified, of them 214 (107 matched-pairs) symptomatic AF (paroxysmal AF: 61%, persistent AF: 39%) patients (age: 67.7 ± 11.2 years) were analyzed. The baseline characteristics were comparable between the two groups. Procedural time was significantly longer in the 4 minutes group compared to 3 minutes group (67.2 ± 21.8 vs 55.9 ± 16.9 minutes, P < .0001). During a mean follow-up of 2 years, the 4 minutes group was associated with a significantly higher rate of freedom from arrhythmia recurrence compared with the 3 minutes group (66.4% vs 56.1%, P = .009), which was mainly driven by patients with persistent AF. The multivariate regression showed that the 4 minutes freeze was the independent predictor of freedom from arrhythmia recurrence. During the repeat procedure, the 4 minutes group was associated with a significantly higher rate of durable PVI. There was no difference regarding procedural adverse events between the two groups.
As compared with the 3 minutes freeze, the TTI guided 4 minutes freeze is associated with a significantly higher rate of arrhythmia-free and durable PVI without compromising the safety profile, patients with persistent AF may benefit from the TTI guided 4 minutes freeze more pronouncedly.
已证明采用隔离时间（TTI）引导的第二代冷冻球囊（CB2）消融术对肺静脉隔离（PVI）有效。
本文旨在比较采用TTI引导的4分钟与3分钟冷冻方案进行CB2 PVI的安全性和临床结果。
这是一项基于机构数据库的倾向匹配研究。连续纳入接受CB2 PVI并进行系统随访的有症状心房颤动（AF）患者。
共识别出573例患者，其中214例（107对匹配组）有症状AF（阵发性AF：61%，持续性AF：39%）患者（年龄：67.7±11.2岁）接受了分析。两组的基线特征具有可比性。4分钟组的手术时间明显长于3分钟组（67.2±21.8对55.9±16.9分钟，P<0.0001）。在平均2年的随访期间，4分钟组与3分钟组相比，心律失常复发的无事件发生率显著更高（66.4%对56.1%，P=0.009），这主要由持续性AF患者驱动。多变量回归显示，4分钟冷冻是心律失常复发无事件的独立预测因素。在重复手术期间，4分钟组的持久PVI发生率显著更高。两组在手术不良事件方面无差异。
与3分钟冷冻相比，TTI引导的第4分钟冷冻与显著更高的无心律失常和持久PVI发生率相关，且不影响安全性，持续性AF患者可能更明显地从TTI引导的4分钟冷冻中获益。
