Mugnai Giacomo, Cecchini Federico, Stroker Erwin, Paparella Gaetano, Iacopino Saverio, Sieira Juan, De Greef Yves, Tomasi Luca, Bolzan Bruna, Bala Gezim, Overeinder Ingrid, Almorad Alexandre, Gauthey Anais, Sorgente Antonio, Ribichini Flavio Luciano, de Asmundis Carlo, Chierchia Gian-Battista
Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium.
Electrophysiology and Cardiac Pacing, Division of Cardiology, Department of Medicine, University Hospital of Verona, Verona, Italy.
Int J Cardiol Heart Vasc. 2022 Apr 27;40:101040. doi: 10.1016/j.ijcha.2022.101040. eCollection 2022 Jun.
The second-generation cryoballoon (CB) has emerged in the last decade as an effective treatment for atrial fibrillation (AF). This study sought to analyze the rate of PV reconnection following CB ablation, evaluate the most frequent PV sites of conduction recovery and finally to assess procedural and biophysical indicators of reconnection in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias.
A total of 300 consecutive patients (189 males, 63%; mean age 63.0 ± 11.1 years) underwent a repeat ablation after 18.2 ± 10.8 months from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 1178 PVs, 209 (17.7%) showed a late PV reconnection in 177 patients (1.18 per patient), at the time of repeat ablation procedure. Overall, persistent PV isolation could be documented in 969 of 1178 PVs (82.3%). In 123 of 300 patients (41%), persistent isolation could be demonstrated in all PVs, whereas PV reconnection could be documented in 177 patients (59%). In the multivariable analysis, nadir temperature (p = 0.03), time to PV isolation (p = 0.01) and failure to achieve - 40 °C within 60 s (p = 0.05) were independently associated with late PV reconnection.
The rate of late PV reconnection after CB ablation was low (1.18 PVs/patient). The most frequent sites of reconnections were the superior-anterior portions for the upper PVs and the inferior-posterior portions for the lower PVs. Faster time to isolation, colder nadir temperatures and achievement of - 40 °C within 60 s were associated with durable PV isolation.
在过去十年中，第二代冷冻球囊（CB）已成为治疗心房颤动（AF）的一种有效方法。本研究旨在分析CB消融术后肺静脉（PV）重新连接的发生率，评估传导恢复最常见的PV部位，并最终评估一大群因房性心律失常复发而接受再次消融的患者中重新连接的手术和生物物理指标。
共有300例连续患者（189例男性，占63%；平均年龄63.0±11.1岁）在首次CB消融术后18.2±10.8个月接受了再次消融。所有再次消融均使用三维电解剖标测系统进行。在所有1178条PV中，209条（17.7%）在再次消融时显示晚期PV重新连接，涉及177例患者（每位患者1.18条）。总体而言，1178条PV中有969条（82.3%）可记录到持续性PV隔离。在300例患者中的123例（41%）中，所有PV均可证明为持续性隔离，而177例患者（59%）可记录到PV重新连接。在多变量分析中，最低温度（p=0.03）、PV隔离时间（p=0.01）以及未能在60秒内达到-40°C（p=0.05）与晚期PV重新连接独立相关。
CB消融术后晚期PV重新连接的发生率较低（每位患者1.18条PV）。重新连接最常见的部位是上PV的上前部和下PV的下后部。更快的隔离时间、更低的最低温度以及在60秒内达到-40°C与持久的PV隔离相关。
