Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Clin Cardiol. 2023 Feb;46(2):142-150. doi: 10.1002/clc.23951. Epub 2022 Nov 29.
Atrial fibrillation (AF) is an uncommon arrhythmia in young adults without structural heart disease, and cryoballoon pulmonary vein isolation (CB-PVI) is an important therapeutic strategy for rhythm control in patients with drug-refractory AF. The aim of this analysis was to evaluate efficacy and safety of CB-PVI in a large cohort of young patients in comparison with middle-aged adults in a real-world setting.
From 2012 to 2020, a total of 3033 patients with AF underwent CB-PVI and were followed prospectively in the framework of the 1STOP Clinical Service project, involving 34 Italian centers. Out of 3033 total 1STOP project subjects, a subgroup of 1318 patients were defined which included a YOUNG group (age ≤ 45 years; n = 368) and a MIDDLE-AGED group (age 60-65 years; n = 950).
The acute success rate of PVI did not differ between the two cohorts (99.9 ± 1.3% vs. 99.8 ± 3.2%, p = 0.415). There was no difference in procedural characteristics, and periprocedural complication rates were similar among the two cohort (1.9% vs. 2.3%, p = 0.646). The 12-month freedom from AF recurrence was 88.9% (95% confidence interval [CI]: 84.7-92.0) in the YOUNG cohort and 85.6% (95% CI: 82.9-88.0) in the MIDDLE-AGED group. At 36-month follow-up, freedom from AF recurrence was 72.4% (65.5%-78.2%) and 71.8% (67.7%-75.6%), respectively with no significant difference among groups (p = 0.550).
CB-PVI had similar efficacy and safety in YOUNG and MIDDLE-AGED patients. Younger age did not affect acute procedural results, complication rate, or AF recurrence after a single procedure.
在无结构性心脏病的年轻成年人中，心房颤动（AF）是一种罕见的心律失常，冷冻球囊肺静脉隔离（CB-PVI）是药物难治性 AF 患者节律控制的重要治疗策略。本分析的目的是在真实环境中比较年轻患者与中年患者的大样本队列中，评估 CB-PVI 的疗效和安全性。
2012 年至 2020 年，共有 3033 例 AF 患者接受 CB-PVI，并在 1STOP 临床服务项目的框架内进行前瞻性随访，涉及 34 个意大利中心。在总共 3033 例 1STOP 项目患者中，定义了一个包含 1318 例患者的亚组，其中包括一个年轻组（年龄≤45 岁；n=368）和一个中年组（年龄 60-65 岁；n=950）。
两组患者的 PVI 即刻成功率无差异（99.9±1.3% vs. 99.8±3.2%，p=0.415）。两组患者的手术特征无差异，围手术期并发症发生率相似（1.9% vs. 2.3%，p=0.646）。年轻组 12 个月无 AF 复发率为 88.9%（95%置信区间：84.7-92.0），中年组为 85.6%（95%置信区间：82.9-88.0）。36 个月随访时，无 AF 复发率分别为 72.4%（65.5%-78.2%）和 71.8%（67.7%-75.6%），两组间无显著差异（p=0.550）。
CB-PVI 在年轻患者和中年患者中的疗效和安全性相似。年龄较轻并不影响单次手术的急性手术结果、并发症发生率或 AF 复发率。
