Heart Rhythm Center, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
Department of Cardiology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan.
Pacing Clin Electrophysiol. 2023 Jun;46(6):475-486. doi: 10.1111/pace.14709. Epub 2023 May 2.
Catheter ablation for non-paroxysmal atrial fibrillation (non-PAF) remains challenging and more effective strategy has been required to reduce postoperative arrhythmia recurrences. This study aims to investigate the efficacy and safety of a novel extensive ablation strategy for non-PAF, that is based on a combination of cryoballoon (CBA), radiofrequency (RFA), and Marshall-vein ethanol ablations (EA-VOM).
The study was a single-center, retrospective observational study. We enrolled 171 consecutive patients who underwent de-novo catheter ablation for non-PAF under conscious sedation with a novel extensive ablation strategy that included CBA for pulmonary vein isolation (PVI) and left atrial roof ablation (LARA), RFA for mitral isthmus (MI) ablation, superior vena cava isolation, and other linear ablations and EA-VOM. Recurrence of atrial arrhythmias over 1 year, procedure outcomes, and procedure-related complications were investigated.
A total of 139 (81.3%) patients remained in sinus rhythm during 1-year follow-up. Of the 139 patients, 51 patients (29.8%) received antiarrhythmic drugs. The mean procedure time was 204 ± 45 min. PVI and LARA ablation by CBA and MI block by RFA and EA-VOM were completed in 171 (100%) and 166 (97.1%) patients, respectively. No serious procedure-related complications were observed except for one case of delayed pericardial effusion.
Approximately 80% of the study patients were AF-free during 1-year follow-up period after a single procedure based on the novel extensive ablation strategy combining CBA, RFA, and EA-VOM. This strategy for non-PAF may be preferred in terms of maintenance of sinus rhythm, safety even in high-risk patients, and relatively short procedure time.
导管消融治疗非阵发性心房颤动（non-PAF）仍然具有挑战性，需要更有效的策略来减少术后心律失常复发。本研究旨在探讨一种新的广泛消融策略治疗非阵发性心房颤动的疗效和安全性，该策略结合了冷冻球囊（CBA）、射频（RFA）和Marshall 静脉乙醇消融（EA-VOM）。
这是一项单中心、回顾性观察研究。我们纳入了 171 例在清醒镇静下接受新的广泛消融策略治疗的非阵发性心房颤动患者，该策略包括 CBA 行肺静脉隔离（PVI）和左心房顶部消融（LARA）、RFA 行二尖瓣峡部消融、上腔静脉隔离及其他线性消融和 EA-VOM。研究调查了 1 年随访期间的心房心律失常复发情况、手术结果和与手术相关的并发症。
在 1 年随访期间，共有 139 例（81.3%）患者维持窦性心律。在这 139 例患者中，51 例（29.8%）患者服用抗心律失常药物。平均手术时间为 204±45 分钟。171 例（100%）患者完成了 CBA 行 PVI 和 LARA 消融，166 例（97.1%）患者完成了 RFA 和 EA-VOM 行 MI 阻滞。除 1 例迟发性心包积液外，未观察到严重的手术相关并发症。
在基于 CBA、RFA 和 EA-VOM 的新的广泛消融策略治疗下，约 80%的患者在 1 年随访期间无房颤发作。对于非阵发性心房颤动，该策略在维持窦性心律、安全性（即使在高危患者中）和相对较短的手术时间方面可能具有优势。
