Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels, Belgium.
J Interv Card Electrophysiol. 2021 Dec;62(3):579-586. doi: 10.1007/s10840-020-00932-6. Epub 2021 Jan 15.
Paroxysmal atrial fibrillation (PAF) can be triggered by non-pulmonary vein foci, like the superior vena cava (SVC). The latter is correlated with improved result in terms of freedom from atrial tachycardias (ATs), when electrical isolation of this vessel utilizing radiofrequency energy (RF) is achieved.
Evaluate the clinical impact, in patients with PAF, of the SVC isolation (SVCi) in addition to ordinary pulmonary vein isolation (PVI) by means of the second-generation cryoballoon (CB) METHODS: A total of 100 consecutive patients that underwent CB ablation for PAF were retrospectively selected. Fifty consecutive patients received PVI followed by SVCi by CB application, and the following 50 consecutive patients received standard PVI. All patients were followed 12 months.
The mean time to SVCi was 36.7 ± 29.0 s and temperature at SVC isolation was - 35 (- 18 to - 40) °C. Real-time recording (RTR) during SVCi was observed in 42 (84.0%) patients. At the end of 12 months of follow-up, freedom from ATs was achieved in 36 (72%) patients in the PVI only group and in 45 (90%) patients of the SVC and PV isolation group (Fisher's exact test p = 0.039, binary logistic regression: p = 0.027, OR = 0.28, 95%CI = 0.09-0.86). In survival analysis, SVC and PV isolation group was also associated with improved freedom from ATs (log-rank test: p = 0.017, Cox regression: p = 0.026, HR = 0.31, 95%CI = 0.11-0.87).
Superior vena cava isolation with the CB in addition to PVI might improve freedom from ATs if compared to PVI alone at 1-year follow-up.
阵发性心房颤动（PAF）可由非肺静脉病灶触发，如上腔静脉（SVC）。当利用射频能量（RF）实现对该血管的电隔离时，后者与无房性心动过速（ATs）的结果改善相关。
通过第二代冷冻球囊（CB）评估 SVC 隔离（SVCi）在 PAF 患者中的临床影响，除了普通的肺静脉隔离（PVI）。
回顾性选择了 100 例接受 CB 消融治疗的 PAF 连续患者。50 例连续患者接受 PVI 后应用 CB 行 SVCi，随后 50 例连续患者接受标准 PVI。所有患者均随访 12 个月。
SVCi 的平均时间为 36.7 ± 29.0 s，SVC 隔离温度为-35（-18 至-40）℃。42 例（84.0%）患者在 SVCi 期间进行了实时记录（RTR）。在 12 个月的随访结束时，在仅行 PVI 的患者中，36 例（72%）患者实现了无 ATs，而在 SVC 和 PV 隔离组的 45 例（90%）患者中实现了无 ATs（Fisher 确切检验 p = 0.039，二项逻辑回归：p = 0.027，OR = 0.28，95%CI = 0.09-0.86）。在生存分析中，SVC 和 PV 隔离组也与改善的无 ATs 相关（对数秩检验：p = 0.017，Cox 回归：p = 0.026，HR = 0.31，95%CI = 0.11-0.87）。
与单独行 PVI 相比，在 1 年随访时，CB 行 SVC 隔离加 PVI 可能改善无 ATs 的情况。
