The Heart Rhythm Center, Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo, 141-0001, Japan.
Heart Vessels. 2021 Nov;36(11):1739-1745. doi: 10.1007/s00380-021-01862-7. Epub 2021 Apr 30.
HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary vein (PV) stenosis remains a concern. The influence of longer application duration on PV stenosis has not yet been systematically evaluated. All patients who underwent first HBPVI of PAF with pre- and post-ablation computed tomography (CT) were included. We used single-shot technique with application duration of 180 s in the RSPV, 180-240 s in the LSPV, and 120 s in the lower PV procedures. PV stenosis was analyzed using CT and categorized as moderate (50-70%), and severe (> 70%) reduction in PV diameter. We analyzed imaging of the PV anatomy before ablation and during follow-up in 84 patients. Among them, 7 (8.3%) showed moderate stenosis, and 3 (3.6%) had severe stenosis including one total occlusion patient. All severe stenosis and total occlusion occurred in RSPV and LSPV procedures with longer application duration. No severe stenosis nor total PV occlusion occurred in inferior PV procedures with shorter application duration. The incidence of PV stenosis ≥ 50% or total PV occlusion was significantly lower in inferior PV than RSPV and LSPV procedures (0.6%, 6.0%, 8.0%, p = 0.01, respectively). All cases of PV stenosis including total PV occlusion patients were asymptomatic. No intervention for PV stenosis was performed. The risk of PV stenosis in HBPVI was rare in lower PV procedure with shorter application duration. An application duration setting of 120 s in lower PV procedure might be effective to prevent PV stenosis.
基于热球囊的肺静脉隔离（HBPVI）在阵发性心房颤动（PAF）的治疗中取得了令人鼓舞的临床结果。然而，肺静脉（PV）狭窄仍然是一个关注点。更长的应用时间对 PV 狭窄的影响尚未得到系统评估。所有接受首次 HBPVI 治疗 PAF 的患者均行术前和术后 CT 检查。我们在下腔静脉的应用时间为 180s，左肺静脉为 180-240s，左肺静脉为 120s。采用单次技术进行分析。PV 狭窄采用 CT 分析，并分为中重度（PV 直径减少 50-70%）和重度（>70%）。我们分析了 84 例患者消融前和随访期间的 PV 解剖结构图像。其中 7 例（8.3%）表现为中度狭窄，3 例（3.6%）有严重狭窄，包括 1 例完全闭塞患者。所有严重狭窄和完全闭塞均发生在应用时间较长的 RSPV 和 LSPV 手术中。在应用时间较短的下腔静脉手术中，没有严重狭窄或总 PV 闭塞。下腔静脉狭窄发生率明显低于 RSPV 和 LSPV 手术（0.6%、6.0%、8.0%，p=0.01）。PV 狭窄≥50%或总 PV 闭塞的发生率在下腔静脉明显低于 RSPV 和 LSPV 手术（0.6%、6.0%、8.0%，p=0.01）。所有 PV 狭窄包括总 PV 闭塞患者均无症状。没有对 PV 狭窄进行干预。在应用时间较短的下腔静脉手术中，HBPVI 的 PV 狭窄风险罕见。在下腔静脉手术中应用 120s 的时间设置可能有助于预防 PV 狭窄。
