使用冷冻球囊与射频消融治疗心房颤动的手术特点和结果：来自 GWTG-AFIB 注册研究的报告。
Procedure characteristics and outcomes of atrial fibrillation ablation procedures using cryoballoon versus radiofrequency ablation: A report from the GWTG-AFIB registry.
机构信息
Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, Connecticut, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
出版信息
J Cardiovasc Electrophysiol. 2021 Feb;32(2):248-259. doi: 10.1111/jce.14858. Epub 2021 Jan 6.
INTRODUCTION
Cryoballoon ablation (CBA) is an alternative to radiofrequency ablation (RFA) for ablation of atrial fibrillation (AF) and real-world comparisons of this strategy are lacking. As such, we sought to compare patient and periprocedural characteristics and outcomes of CBA versus RFA in the Get With the Guidelines AFIB Registry.
METHODS
Categorical variables were compared via the χ test and continuous variables were compared via the Wilcoxon rank-sum test. Adjusted analyses were performed using overlap weighting of propensity scores.
RESULTS
A total of 5247 (1465 CBA, 3782 RFA) ablation procedures were reported from 33 sites. Those undergoing CBA more often had paroxysmal AF (60.0% vs. 48.8%) and no prior AF ablation (87.5% vs. 73.8%). CHA DS -VASc scores were similar. Among de novo ablations, most ablations involved intracardiac echocardiography and electroanatomic mapping, but both were less common with CBA (87.3% vs. 93.9%, p < .0001, and 87.7% vs. 94.6%, p < .0001, respectively). CBA was associated with shorter procedures (129 vs. 179 min, p < .0001), increased fluoroscopy use (19 vs. 11 min, p < .0001), and similar ablation times (27 vs. 35 min, p = .15). Nonpulmonary vein ablation was common with CBA: roof line 38.6%, floor line 20.4%, cavotricuspid isthmus 27.7%. RFA was associated with more total complications compared to CBA (5.4% vs. 2.3%, p < .0001), due to more volume overload and "other" events, although phrenic nerve injury was more common with CBA (0.9% vs 0.1%, p = .0001). In the adjusted model, any complication was less common among CBA cases (odds ratio, 0.45; confidence interval, 0.25-0.79, p = .0056).
CONCLUSION
CBA was associated with fewer complications, and shorter procedure times, and greater fluoroscopy times, compared to RFA. Nonpulmonary vein ablation and electroanatomic mapping system use was common with CBA.
介绍
冷冻球囊消融术（CBA）是房颤消融治疗的一种替代方法，与射频消融术（RFA）相比，目前还缺乏真实世界的比较。因此，我们试图在 Get With the Guidelines AFIB 登记处比较 CBA 与 RFA 患者的特点和围手术期结局。
方法
通过卡方检验比较分类变量，通过 Wilcoxon 秩和检验比较连续变量。采用倾向评分重叠加权进行校正分析。
结果
33 个中心共报告了 5247 例（1465 例 CBA，3782 例 RFA）消融手术。接受 CBA 的患者更常患有阵发性房颤（60.0% vs. 48.8%）和无既往房颤消融史（87.5% vs. 73.8%）。CHA2DS2-VASc 评分相似。在初次消融中，大多数消融涉及心内超声和电生理标测，但 CBA 较少使用（87.3% vs. 93.9%，p<0.0001 和 87.7% vs. 94.6%，p<0.0001）。CBA 与手术时间更短（129 分钟 vs. 179 分钟，p<0.0001）、透视时间更长（19 分钟 vs. 11 分钟，p<0.0001）有关，消融时间相似（27 分钟 vs. 35 分钟，p=0.15）。CBA 常见非肺静脉消融：房顶线 38.6%，房室结峡部 20.4%，三尖瓣环峡部 27.7%。与 CBA 相比，RFA 更易发生总并发症（5.4% vs. 2.3%，p<0.0001），这是由于容量超负荷和“其他”事件更多，但 CBA 更易发生膈神经损伤（0.9% vs 0.1%，p=0.0001）。在调整模型中，CBA 患者的任何并发症发生率均较低（比值比，0.45；95%置信区间，0.25-0.79，p=0.0056）。
结论
与 RFA 相比，CBA 与较少的并发症、较短的手术时间和更多的透视时间相关。非肺静脉消融和电生理标测系统的使用在 CBA 中很常见。
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