Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain.
Hospital Universitario Vírgen de la Victoria, Málaga, Spain.
Cardiol J. 2024;31(2):193-204. doi: 10.5603/CJ.a2023.0017. Epub 2023 Mar 13.
Ablation of atrial fibrillation (AF), both cryoablation ablation (CBA) and radiofrequency catheter ablation (RFCA), have demonstrated to be safe and effective. About 1 in 3 patients may face a redo due to recurrence and the best technique is unknown. The aim of this study is to assess the efficacy of CBA as a repeat procedure in patients with prior CBA or RFCA.
A nation-wide CBA registry (RECABA) was analyzed and patients were compared who had previously undergone CBA (Prior-CB) or RFCA (Prior-RF). The primary endpoint was AF recurrence at 12 months after a 3-month blanking period. A survival analysis was performed, univariate and multivariate Cox models were also built.
Seventy-four patients were included. Thirty-three (44.6%) were in the Prior-CB group and 41 (55.4%) in the Prior-RF. There were more reconnected pulmonary veins in the Prior-RF than in Prior-CB group (40.4% vs.16.5%, p = 0.0001). The 12-month Kaplan-Meier estimate of freedom from AF recurrence after the blanking period was 61.0% (95% confidence interval [CI] 41.4-75.8%) in the Prior-CB, and 89.2% (95% CI 73.6-95.9%) in the Prior-RF group (p = 0.002). Multivariate Cox regression pointed Prior-CB as the sole independent predictor of AF recurrence, with an adjusted HR of 2.67 (95% CI 1.05-6.79).
Repeat CBA shows higher rates of AF recurrences compared to CBA after a previous RFCA despite presenting less reconnected veins at the procedure. These data suggest that patients with AF recurrence after CBA may benefit from other ablation techniques after a recurrence. RECABA is registered at clinicaltrials.gov with the Unique Identifier NCT02785991.
消融术（包括冷冻消融和射频导管消融）治疗心房颤动（房颤）已被证明是安全有效的。约有 1/3 的患者可能因复发而需要再次治疗，但其最佳技术尚不清楚。本研究旨在评估既往接受冷冻消融术（CBA）或射频导管消融术（RFCA）的患者再次行 CBA 的疗效。
对全国性的 CBA 注册研究（RECABA）进行了分析，并比较了先前接受 CBA（既往-CBA）或 RFCA（既往-RF）的患者。主要终点为空白期 3 个月后 12 个月时的房颤复发情况。进行了生存分析，同时还构建了单变量和多变量 Cox 模型。
共纳入 74 例患者。其中 33 例（44.6%）为既往-CBA 组，41 例（55.4%）为既往-RF 组。既往-RF 组中再通的肺静脉多于既往-CBA 组（40.4% vs. 16.5%，p=0.0001）。空白期后 12 个月时，既往-CBA 组和既往-RF 组无房颤复发的 Kaplan-Meier 估计值分别为 61.0%（95%置信区间[CI]41.4-75.8%）和 89.2%（95% CI 73.6-95.9%）（p=0.002）。多变量 Cox 回归分析表明，既往-CBA 是房颤复发的唯一独立预测因素，调整后的 HR 为 2.67（95% CI 1.05-6.79）。
尽管 CBA 术后再次行 CBA 时，肺静脉再通的比例较低，但与再次行 RFCA 相比，复发率更高。这些数据表明，CBA 术后复发的房颤患者可能会从复发后的其他消融技术中获益。RECABA 已在 clinicaltrials.gov 注册，注册号为 NCT02785991。
