Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
J Cardiovasc Electrophysiol. 2022 Jun;33(6):1096-1103. doi: 10.1111/jce.15453. Epub 2022 Mar 25.
Cryoballoon (CB)-based pulmonary vein isolation (PVI) has proven to be as effective as radiofrequency-based ablation. Different ablation protocols took the individual time-to-isolation (TTI) into account aiming at shorter but equally or even more effective freeze cycles. The current study sought to assess the impact of the TTI on PVI durability in patients undergoing a repeat procedure for recurrence of atrial tachyarrhythmia (ATA).
In 205 patients with ATA recurrence after previous CB-based PVI, a total of 806 pulmonary veins (PVs) were identified. A total of 126 out of 806 PVs (16%) were previously treated with a TTI-guided ablation (Protocol #1; TTI + 120 s), in 92/806 (11%) PVs TTI was only monitored (m) but fixed freeze cycles were applied (Protocol #2; mTTI) and in 588/806 (73%) a fixed freeze cycle was applied without mTTI. There was no difference in the PV-reconduction rate between the groups (p = .23). The right inferior pulmonary vein (RIPV) showed overall significantly higher reconduction rates compared to the other PVs (RIPV-left inferior PV p < .003, -left superior PV p < .001, -right superior PV p < .013). Twenty-one patients (10%) were demonstrated to have only electrical reconduction of the RIPV, while all other PVs were still electrically isolated.
The TTI-based CB ablation protocol did not show significant differences regarding PV-reconduction rates compared to the other ablation protocols.
基于冷冻球囊（CB）的肺静脉隔离（PVI）已被证明与基于射频的消融同样有效。不同的消融方案考虑了个体的隔离时间（TTI），旨在实现更短但同样有效或更有效的冷冻周期。本研究旨在评估在因房性心动过速（ATA）复发而接受重复 CB 基 PVI 的患者中，TTI 对 PVI 耐久性的影响。
在 205 例先前 CB 基 PVI 后 ATA 复发的患者中，共识别出 806 条肺静脉（PV）。在 806 条 PV 中有 126 条（16%）之前采用 TTI 指导消融（方案 #1；TTI+120 秒），92 条（11%）仅监测 TTI（m）但应用固定冷冻周期（方案 #2；mTTI），588 条（73%）无 mTTI 应用固定冷冻周期。各组之间的 PV 再传导率无差异（p=0.23）。与其他 PV 相比，右下肺静脉（RIPV）总体上显示出更高的再传导率（RIPV-左下肺静脉 p<0.003，-左上肺静脉 p<0.001，-右上肺静脉 p<0.013）。21 例患者（10%）仅显示 RIPV 的电再传导，而所有其他 PV 仍保持电隔离。
与其他消融方案相比，基于 TTI 的 CB 消融方案在 PV 再传导率方面没有显著差异。
