Cardiac Arrhythmia Service, Amiens-Picardie University Medical Center, Amiens, France.
Biostatistics Unit, Clinical Research and Innovation Directorate, Amiens-Picardie University Medical Center, Amiens, France.
Arch Cardiovasc Dis. 2022 May;115(5):252-263. doi: 10.1016/j.acvd.2022.02.006. Epub 2022 Mar 4.
There is no consensus on the most effective radiofrequency ablation strategy for the initial or repeated treatment of persistent atrial tachyarrhythmia (ATa).
To describe success and complication rates after the creation of left atrial (LA) linear lesions for recurrent persistent ATa following an index cryoballoon pulmonary vein isolation (PVI), and to identify predictors of ATa recurrence.
During March 2013 to March 2020, we prospectively included all consecutive patients undergoing repeat procedures for the treatment of persistent ATa. Radiofrequency ablation consisting of the creation of linear lesions: a roofline, a mitral isthmus and/or septal line, and a cavotricuspid isthmus line. All patients were prospectively followed up for ATa recurrence.
Overall, 133 patients underwent 170 procedures after initial cryoballoon PVI (n=715). At least one pulmonary vein reconnection was observed in 60 patients (45.1%), all of whom underwent successful re-disconnection. After all the procedures, >90% of patients had a lesion pattern consisting of a roofline, a mitral isthmus and/or septal line, and a cavotricuspid isthmus line. ATa was terminated in 41 patients (35%). There were three cases of tamponade (3/170 procedures, 1.8%). Ninety-two patients (69.2%) were in sinus rhythm after a median (interquartile range) of 36 (21-53) months since the index cryoballoon PVI. Diagnosis-to-ablation time and LA area were predictors of recurrence in multivariable analysis.
The creation of linear lesions is a safe and effective treatment strategy for the recurrence of persistent ATa after cryoballoon PVI. Longer diagnosis-to-ablation time and larger LA area were predictive of ATa recurrence.
对于持续性房性心动过速（ATa）的初始或重复治疗，哪种射频消融策略最有效尚无共识。
描述在指数冷冻球囊肺静脉隔离（PVI）后，用于治疗复发性持续性 ATa 的左心房（LA）线性消融的成功率和并发症发生率，并确定 ATa 复发的预测因素。
在 2013 年 3 月至 2020 年 3 月期间，我们前瞻性地纳入了所有连续接受持续性 ATa 治疗的重复手术的患者。射频消融包括线性消融线的创建：房顶线、二尖瓣峡部和/或间隔线和腔静脉峡部线。所有患者均前瞻性随访 ATa 复发情况。
总体而言，在初始冷冻球囊 PVI 后，133 名患者共进行了 170 次手术（n=715）。60 名患者（45.1%）观察到至少一条肺静脉再连接，所有患者均成功再断开。在所有手术后，超过 90%的患者的消融线模式包括房顶线、二尖瓣峡部和/或间隔线和腔静脉峡部线。41 名患者（35%）的 ATa 终止。有 3 例（170 例中的 3 例，3%）发生心包填塞。在指数冷冻球囊 PVI 后中位数（四分位距）36（21-53）个月后，92 名患者（69.2%）窦性心律。多变量分析显示，诊断到消融的时间和 LA 面积是复发的预测因素。
在冷冻球囊 PVI 后，线性消融线的创建是治疗持续性 ATa 复发的一种安全有效的治疗策略。较长的诊断到消融时间和较大的 LA 面积是 ATa 复发的预测因素。
