Pilichowska-Paszkiet Ewa, Sikorska Agnieszka, Kowalik Ilona, Smarż Krzysztof, Sikora-Frąc Małgorzata, Baran Jakub, Piotrowski Roman, Kryński Tomasz, Kułakowski Piotr, Zaborska Beata
Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, 04-073 Warsaw, Poland.
Clinical Research Support Center, National Institute of Cardiology, 04-073 Warsaw, Poland.
J Clin Med. 2023 Jul 28;12(15):4974. doi: 10.3390/jcm12154974.
It has been suggested that cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency (RF) ablation; however, results are conflicting. We sought to address this issue using modern echocardiographic techniques estimating the LA function after successful CB and RF ablation for PAF. A total of 90 patients (66% males, mean age 57 ± 10 years) successfully treated (no AF recurrences confirmed in serial 4-7 day ECG Holter monitoring) with RF (51%) or CB (49%) ablation for PAF were retrospectively studied. Echocardiography with speckle tracking (STE) was performed before and 12 months after the procedure. The peak longitudinal LA strain (LAS) and strain rate (LASR) during the reservoir (r), conduit (cd), and contraction (ct) phases were measured in sinus rhythm. Analysis of covariance was applied to compare changes in the echocardiographic parameters over time with the baseline measurements as covariance and the type of ablation as the factor. The parallelism of the slopes of the covariance was tested. The LA diameter decreased (38.3 ± 4.1 mm vs. 36.8 ± 3.6 mm, < 0.001) in the whole study group at 12 months after ablation. The LASRr and LASRcd increased (1.1 ± 0.3 s¹ vs. 1.3 ± 0.3 s¹, < 0.001 and 1.1 ± 0.3 s¹ vs. 1.2 ± 0.3 s¹, < 0.001, respectively) whereas other LA strain parameters remained unchanged in the whole study group at 12 months after ablation. In the analysis of LA function at 12 months after the procedure regarding the mode of ablation, the worsening of parameters reflecting LA compliance was observed in patients with better pre-served baseline values in the CB ablation subgroup. For baseline LAScd >28%, the difference ΔCB - ΔRF was -7.6 (11.7; -3.4), < 0.001, and for baseline LAScd >16%, ΔCB - ΔRF was -1.8 (-3.2; -0.4), = 0.014. The traditional Doppler-derived parameter e' showed the same trend-for baseline e' ≥12 cm/s, ΔCB - ΔRF was -1.7 (-2.8; -0.6), = 0.003. We conclude that worsening of parameters reflecting LA compliance was observed 12 months after CB ablation compared to RF ablation for PAF in patients who underwent a successful procedure and had better-preserved baseline LA function. This might suggest subclinical dysfunction of LA after the CB ablation procedure. The clinical significance of these findings warrants further investigations.
有人提出，冷冻球囊（CB）消融阵发性心房颤动（PAF）可能比射频（RF）消融导致更广泛的左心房（LA）损伤；然而，结果相互矛盾。我们试图使用现代超声心动图技术来解决这个问题，该技术可在成功进行CB和RF消融PAF后评估LA功能。对90例成功接受PAF的RF（51%）或CB（49%）消融治疗（在连续4 - 7天的心电图动态监测中未确认房颤复发）的患者进行回顾性研究。在手术前和术后12个月进行斑点追踪超声心动图（STE）检查。在窦性心律下测量LA在储存期（r）、管道期（cd）和收缩期（ct）的纵向峰值应变（LAS）和应变率（LASR）。应用协方差分析来比较超声心动图参数随时间的变化与基线测量值作为协变量，消融类型作为因素。检验协方差斜率的平行性。消融后12个月，整个研究组的LA直径减小（38.3±4.1mm对36.8±3.6mm，<0.001）。LASRr和LASRcd增加（分别为1.1±0.3s⁻¹对1.3±0.3s⁻¹，<0.001和1.1±0.3s⁻¹对1.2±0.3s⁻¹，<0.001），而消融后12个月整个研究组的其他LA应变参数保持不变。在手术后12个月关于消融方式的LA功能分析中，在CB消融亚组中基线值保存较好的患者中观察到反映LA顺应性的参数恶化。对于基线LAScd>28%，差异ΔCB - ΔRF为 -7.6（11.7； -3.4），<0.001，对于基线LAScd>16%，ΔCB - ΔRF为 -1.8（ -3.2； -0.4），=0.014。传统的多普勒衍生参数e'显示相同趋势 - 对于基线e'≥12cm/s，ΔCB - ΔRF为 -1.7（ -2.8； -0.6），=0.003。我们得出结论，与成功接受手术且基线LA功能保存较好的PAF患者的RF消融相比，CB消融后12个月观察到反映LA顺应性的参数恶化。这可能提示CB消融术后LA存在亚临床功能障碍。这些发现的临床意义值得进一步研究。
