Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Expert Rev Med Devices. 2022 Aug;19(8):623-631. doi: 10.1080/17434440.2022.2129008. Epub 2022 Oct 3.
Atrial fibrillation (AF) is a common chronic and progressive heart rhythm disorder. For those in whom sinus rhythm is desired, contemporary clinical practice guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy. However, these medications have modest efficacy and are associated with significant adverse effects.
The current article reviews the evidence surrounding first-line catheter ablation, particularly the emerging evidence surrounding the use of cryoballoon ablation as a first-line therapy. The focus of the review is on the outcomes of arrhythmia freedom, quality of life, health-care utilization, and safety. In addition, the article will review novel cryoablation systems.
Recent evidence suggests that cryoballoon ablation significantly improves arrhythmia outcomes (e.g. freedom from any atrial tachyarrhythmia or symptomatic atrial tachyarrhythmia, reduction in arrhythmia burden), patient-reported outcomes (e.g. symptoms and quality of life), and health-care resource utilization (e.g. hospitalization), without increasing the risk of adverse events. These findings are relevant to patients, providers, and health-care systems, as they help inform the decision-making regarding the initial choice of rhythm-control therapy in patients with treatment-naive AF.
心房颤动（AF）是一种常见的慢性进行性心律不齐。对于那些希望恢复窦性心律的患者，当代临床实践指南推荐抗心律失常药物（AADs）作为初始治疗方法。然而，这些药物的疗效有限，且伴有显著的不良反应。
本文综述了一线导管消融的相关证据，特别是关于冷冻球囊消融作为一线治疗方法的新证据。本文的重点是心律失常无复发率、生活质量、医疗保健利用率和安全性等方面的结果。此外，本文还将回顾新型冷冻消融系统。
最近的证据表明，冷冻球囊消融术显著改善了心律失常的结果（例如，任何房性快速性心律失常或有症状的房性快速性心律失常的无复发率，心律失常负荷的减少）、患者报告的结果（例如，症状和生活质量）和医疗保健资源利用率（例如，住院），而不会增加不良事件的风险。这些发现与患者、医疗服务提供者和医疗保健系统相关，因为它们有助于为治疗初发 AF 的患者选择节律控制治疗的初始方案提供决策依据。
