Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany.
Centro Cardiologico Monzino, Milano, Italy.
Europace. 2021 Jun 7;23(6):868-877. doi: 10.1093/europace/euaa406.
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety in a high volume centre with a long experience in the use of the second-generation CB (CB2).
Consecutive paroxysmal AF (PAF) or persistent AF (persAF) patients undergoing CB2-PVI were enrolled. Procedural data, efficacy, and safety issues were systematically collected. The 28 mm CB2 was used in combination with an inner lumen spiral catheter, a luminal oesophageal temperature (LET) probe was used with a cut-off of 15°C, the phrenic nerve (PN) monitored during septal PVs ablation. Freeze duration was mainly set at 240 s with a bonus application in case of delayed time-to-isolation (TTI > 75 s). A total of 1017 CB2 procedures were analysed (58% male, 66 ± 12 years old, 70% with PAF). 3964 PVs were identified, 99.8% PVs isolated using solely the 28 mm CB. Mean procedure time was 69 ± 25 min, TTI during the first application was recorded in 77% of PVs after a mean of 48 ± 31 s. We recorded 0.2% cardiac tamponade, 4.8% PN injury (1.6% of PN palsy), and 19% of LET < 15°C. Among 725 patients with follow-up data, 84% with PAF and 75% with persAF were in stable SR at 1 year. Shorter freezing duration and longer TTI were procedural predictors for recurrence.
Cryoballoon procedures are fast and associated with a benign safety profile. Shorter TTI and longer freeze durations are associated with sinus rhythm during follow-up.
冷冻球囊（CB）肺静脉隔离（PVI）是一种用于治疗心房颤动（AF）的节律控制的可接受的消融策略。我们描述了在一个具有第二代 CB（CB2）丰富使用经验的大容量中心的疗效和安全性。
连续入选接受 CB2-PVI 的阵发性 AF（PAF）或持续性 AF（persAF）患者。系统收集了手术数据、疗效和安全性问题。使用 28mm CB2 联合内管螺旋导管，使用 15°C 截止的腔内食管温度（LET）探头，在间隔 PVs 消融时监测膈神经（PN）。冷冻持续时间主要设置为 240s，如果隔离时间延迟（TTI>75s），则应用额外的冷冻时间。共分析了 1017 例 CB2 手术（58%为男性，66±12 岁，70%为 PAF）。共识别 3964 个 PV，99.8%的 PV 仅使用 28mm CB 隔离。平均手术时间为 69±25min，在第一次应用中，77%的 PV 在平均 48±31s 后记录到 TTI。我们记录到 0.2%的心包填塞，4.8%的 PN 损伤（1.6%的 PN 瘫痪）和 19%的 LET<15°C。在 725 例有随访数据的患者中，84%的 PAF 和 75%的 persAF 在 1 年内保持稳定的窦性节律。较短的冷冻时间和较长的 TTI 是与随访期间窦性节律相关的手术预测因素。
冷冻球囊手术快速且安全性良好。较短的 TTI 和较长的冷冻时间与随访期间的窦性节律相关。
