Larsen Jacob M, Deyell Marc W, Macle Laurent, Champagne Jean, Sarrazin Jean-Francois, Leong-Sit Peter, Badra-Verdu Mariano, Sapp John, Khairy Paul, Andrade Jason G
Department of Cardiology, Aalborg University Hospital, Denmark.
Heart Rhythm Services, Department of Medicine, University of British Columbia, Canada.
J Cardiovasc Electrophysiol. 2020 Jul 6. doi: 10.1111/jce.14652.
Concerns remain regarding the effectiveness of PVI using the fixed diameter non-compliant cryoballoon in the presence of a left common pulmonary vein (LCPV). We sought to evaluate the effectiveness of PVI performed by contact-force guided radiofrequency (CF-RF) versus second-generation cryoballoon-based ablation in patients with LCPV.
We enrolled 346 patients with paroxysmal AF and randomized them to CF-RF or cryoballoon ablation. PV anatomy was not assessed prior to enrolment, and there were no exclusions based on PV anatomy. All patients received an implantable cardiac monitor. LCPV was observed in 13.6% of patients (47/346). Left atrial time and fluoroscopy time did not differ between those with and without LCPV (P=0.58 and P=0.06, respectively). Freedom from any atrial tachyarrhythmia at one year was observed in 46.8% with LCPV and 54.5% without LCPV (P=0.06). In those with LCPV the freedom from any atrial tachyarrhythmia did not differ between those randomized to CF-RF or cryoballoon ablation (HR for recurrence 1.19, 95% CI 0.53-2.65, P=0.69). In those with LCPV the AF burden was reduced to a similar extent with CF-RF and cryoballoon ablation (99.7% vs. 99.5%, respectively; P=0.97).
In this randomized clinical trial, the presence of a LCPV was associated with a trend towards higher rates of arrhythmia recurrence following PVI. No significant difference in arrhythmia recurrence was observed between patients with LCPV randomized to cryoballoon ablation or contact-force guided RF ablation, suggesting that either ablation modality is suitable in this population. (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation [CIRCA-DOSE], NCT01913522) This article is protected by copyright. All rights reserved.
对于在存在左肺总静脉（LCPV）的情况下使用固定直径非顺应性冷冻球囊进行肺静脉隔离（PVI）的有效性仍存在担忧。我们试图评估在LCPV患者中，接触力引导下的射频（CF-RF）与第二代冷冻球囊消融进行PVI的有效性。
我们纳入了346例阵发性房颤患者，并将他们随机分为CF-RF组或冷冻球囊消融组。入组前未评估肺静脉解剖结构，且未基于肺静脉解剖结构进行排除。所有患者均植入了植入式心脏监测器。13.6%的患者（47/346）观察到LCPV。有LCPV和无LCPV患者的左心房时间和透视时间无差异（分别为P = 0.58和P = 0.06）。有LCPV的患者中，一年无任何房性快速心律失常的比例为46.8%，无LCPV的患者为54.5%（P = 0.06）。在有LCPV的患者中，随机接受CF-RF或冷冻球囊消融的患者无任何房性快速心律失常的情况无差异（复发风险比为1.19，95%可信区间为0.53 - 2.65，P = 0.69）。在有LCPV的患者中，CF-RF和冷冻球囊消融使房颤负荷降低的程度相似（分别为99.7%和99.5%；P = 0.97）。
在这项随机临床试验中，LCPV的存在与PVI后心律失常复发率较高的趋势相关。在随机接受冷冻球囊消融或接触力引导下射频消融的LCPV患者中，未观察到心律失常复发的显著差异，这表明这两种消融方式在该人群中均适用。（冷冻球囊与灌注射频导管消融[CIRCA-DOSE]，NCT01913522）本文受版权保护。保留所有权利。
