Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, Shinjuku-ku, Tokyo, Japan.
Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Open Heart. 2022 Jan;9(1). doi: 10.1136/openhrt-2021-001724.
The limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic analysis on procedural success rate, atrial fibrillation (AF) recurrence rate and complications of cryoballoon ablation in association with the anatomy of the left atrium and PV based on preprocedural CT to gain insights into proper treatments of patients with AF using cryoballoon.
A systematic search of literature databases, including PubMed, Web of Science and Cochrane Library, from the inception of each database through February 2021 was conducted. Search keywords included 'atrial fibrillation', 'cryoballoon ablation' and 'anatomy'.
Overall, 243 articles were identified. After screening, 16 articles comprising 1396 patients were included (3, 5 and 8 for acute success, AF recurrence and complications, respectively). Regarding acute success and AF recurrences, thinner width of the left lateral ridge, higher PV ovality, PV ostium-bifurcation distance, shorter distance from the non-coronary cusp to inferior PVs, shallower angle of right PVs against the atrial septum and larger right superior PV (RSPV) were associated with poor outcomes. Regarding complications, shorter distance between the RSPV ostium and the right phrenic nerve, larger RSPV-left atrium angle, larger RSPV area and smaller right carina width were associated with incidences of phrenic nerve injury.
This study elucidated several key anatomical features of PVs possibly affecting acute success, AF recurrence and complications in patients with AF using cryoballoon ablation. CT analysis has helped to describe benefits and anatomical limitations for cryoballoon ablation.
冷冻球囊的球囊尺寸有限，导致肺静脉（PV）隔离的解剖限制。我们基于术前 CT 对左心房和 PV 的解剖结构进行了全面的系统分析，以获得使用冷冻球囊治疗 AF 患者的见解，分析了冷冻球囊消融术与左心房和 PV 解剖结构相关的程序成功率、房颤（AF）复发率和并发症。
系统检索了包括 PubMed、Web of Science 和 Cochrane Library 在内的文献数据库，检索时间从每个数据库的创建时间到 2021 年 2 月。搜索关键词包括“房颤”、“冷冻球囊消融”和“解剖”。
共确定了 243 篇文章。经过筛选，纳入了 16 篇文章，共包括 1396 例患者（分别为 3 篇、5 篇和 8 篇用于急性成功、AF 复发和并发症）。就急性成功和 AF 复发而言，左侧侧嵴较薄、PV 卵圆形较高、PV 口分叉距离较长、从非冠状动脉瓣到下 PV 的距离较短、右 PV 与房间隔的夹角较浅、RSPV 较大与不良结果相关。关于并发症，RSPV 口与右膈神经之间的距离较短、RSPV-左心房角度较大、RSPV 面积较大和右嵴宽度较小与膈神经损伤的发生率相关。
本研究阐明了几个可能影响使用冷冻球囊消融术治疗 AF 患者的急性成功、AF 复发和并发症的 PV 关键解剖特征。CT 分析有助于描述冷冻球囊消融的获益和解剖局限性。
