Vallès Ermengol, Jiménez Jesús, Martí-Almor Julio, Toquero Jorge, Ormaetxe José Miguel, Barrera Alberto, García-Alberola Arcadio, Rubio José Manuel, Moriña Pablo, Grande Carlos, Fé Arcocha Maria, Peinado Rafael, Cózar Rocío, Hernández Julio, Pérez-Alvarez Luisa, Gaztañaga Larraitz, Ferrero-De Loma-Osorio Angel, Ruiz-Granell Ricardo, Villuendas Roger, Martínez-Alday Jesús Daniel
Hospital del Mar, Universitat Autònoma de Barcelona, IMIM, 08003 Barcelona, Spain.
Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain.
J Clin Med. 2022 Feb 22;11(5):1166. doi: 10.3390/jcm11051166.
Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8 ± 10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs. 11.4%; p < 0.001) and left atrium dilation (72.6 vs. 43.3%; p < 0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs. 22.2%; p < 0.001), with an arterial line (32.2 vs. 44.6%; p < 0.001) and assisted transeptal puncture (11.9 vs. 17.9%; p = 0.025). During an application, PeAF patients had a longer time to −30 °C (35.91 ± 14.20 vs. 34.93 ± 12.87 s; p = 0.021) and a colder balloon nadir temperature during vein isolation (−35.04 ± 9.58 vs. −33.61 ± 10.32 °C; p = 0.004), but received fewer bonus freeze applications (30.7 vs. 41.1%; p < 0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p = 0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.
冷冻球囊消融术(CBA)已成为阵发性心房颤动(PaAF)的标准治疗方法,但关于持续性心房颤动(PeAF)患者治疗结果的数据有限。方法:我们分析了西班牙前瞻性多中心上市后观察登记研究纳入的首批944例患者,以比较接受CBA治疗的PeAF患者与PaAF患者的特征和治疗结果。结果:来自25个中心的944例房颤患者(年龄57.8±10.4岁;70.1%为男性)被前瞻性纳入研究,其中27.9%为持续性房颤。PeAF患者更易患结构性心脏病(67.7%对11.4%;p<0.001)和左心房扩大(72.6%对43.3%;p<0.001)。PeAF患者接受CBA时,在全身麻醉下进行手术的可能性较小(10.7%对22.2%;p<0.001),使用动脉置管的可能性较小(32.2%对44.6%;p<0.001),辅助经房间隔穿刺的可能性较小(11.9%对17.9%;p=0.025)。在一次消融过程中,PeAF患者达到-30°C的时间更长(35.91±14.20秒对34.93±12.87秒;p=0.021),在肺静脉隔离期间球囊最低点温度更低(-35.04±9.58°C对-33.61±10.32°C;p=0.004),但额外冷冻消融的次数更少(30.7%对41.1%;p<0.001)。急性肺静脉隔离和手术相关并发症方面无差异。总体而言,在15个月的随访中,76.7%的患者无房颤复发(PaAF患者为78.9%,PeAF患者为70.9%;p=0.09)。结论:PeAF患者的病变基础更严重,此类患者进行的CBA手术更为简化,尽管通常会进行更长时间/更低温度的冷冻消融。PaAF患者和PeAF患者CBA的急性疗效/安全性相似,但PaAF患者的长期结果更好。