Yano Masamichi, Egami Yasuyuki, Kawanami Shodai, Ukita Kohei, Kawamura Akito, Yasumoto Koji, Tsuda Masaki, Okamoto Naotaka, Matsunaga-Lee Yasuharu, Nishino Masami
Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Am J Cardiol. 2024 Jun 1;220:1-8. doi: 10.1016/j.amjcard.2024.03.018. Epub 2024 Mar 24.
Pulmonary vein isolation (PVI) causes changes in P-wave parameters. However, the difference in changes in P-wave parameters including P-wave vector magnitude (Pvm) between radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA) remains unknown. Paroxysmal atrial fibrillation (PAF) patients who underwent only PVI were enrolled. Pvm was calculated by the square root of the sum of the squared P-wave amplitude in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were divided into 2 groups: RFCA and CBA. ΔPvm was calculated as ΔPvm (mV) = (Pvm at pre-PVI)-(Pvm at post-PVI). The following factors were evaluated: (1) differences in the ΔPvm between the 2 groups, (2) relation between late arrhythmia recurrence and ΔPvm in RFCA and CBA groups, and (3) the impact of relevant factors on ΔPvm. The study population included a total of 426 patients with PAF (RFCA, 167 patients; CBA, 259 patients). ΔPvm was significantly larger in CBA than in RFCA (p <0.001). Kaplan-Meier analysis showed late arrhythmia recurrence was significantly higher in patients with low ΔPvm (<0.019 mV) than high ΔPvm (≥0.019 mV) in RFCA (Log-rank p <0.001), and low ΔPvm (<0.033 mV) than high ΔPvm (≥0.033 mV) in CBA (Log-rank p <0.001). Multiple regression analysis showed that CBA and heart rate change were independently and significantly associated with ΔPvm (p <0.001 and p <0.001, respectively). In conclusion, ΔPvm was significantly larger in CBA than RFCA during procedure. Low ΔPvm had a higher risk of late arrhythmia recurrence in RFCA and CBA.
肺静脉隔离（PVI）会引起P波参数的变化。然而，射频导管消融（RFCA）和冷冻球囊消融（CBA）之间P波参数变化的差异，包括P波向量大小（Pvm），仍然未知。纳入仅接受PVI的阵发性心房颤动（PAF）患者。Pvm通过II导联和V6导联中P波振幅平方和加上V2导联中P波振幅的一半的平方根来计算。患者分为两组：RFCA组和CBA组。ΔPvm计算为ΔPvm（mV）=（PVI前的Pvm）-（PVI后的Pvm）。评估以下因素：（1）两组之间ΔPvm的差异；（2）RFCA组和CBA组中晚期心律失常复发与ΔPvm的关系；（3）相关因素对ΔPvm的影响。研究人群包括总共426例PAF患者（RFCA组167例；CBA组259例）。CBA组的ΔPvm显著大于RFCA组（p<0.001）。Kaplan-Meier分析显示，RFCA组中ΔPvm低（<0.019 mV）的患者晚期心律失常复发率显著高于ΔPvm高（≥0.019 mV）的患者（对数秩检验p<0.001），CBA组中ΔPvm低（<0.033 mV）的患者晚期心律失常复发率显著高于ΔPvm高（≥0.033 mV）的患者（对数秩检验p<0.001）。多元回归分析显示，CBA和心率变化与ΔPvm独立且显著相关（分别为p<0.001和p<0.001）。总之，术中CBA组的ΔPvm显著大于RFCA组。RFCA组和CBA组中，ΔPvm低的患者晚期心律失常复发风险更高。
