Odagiri Fuminori, Tokano Takashi, Miyazaki Tetsuro, Hirabayashi Koji, Ishi Kai, Abe Hiroshi, Ishiwata Sayaki, Kakihara Midori, Maki Masaaki, Matsumoto Hiroki, Shimai Ryosuke, Aikawa Tadao, Takano Shintaro, Kimura Yuki, Kuroda Shunsuke, Isogai Hiroyuki, Ozaki Dai, Shiozawa Tomoyuki, Yasuda Yuki, Takasu Kiyoshi, Iijima Kenichi, Takamura Kazuhisa, Matsubara Tomomi, Tabuchi Haruna, Hayashi Hidemori, Yokoyama Ken, Sekita Gaku, Sumiyoshi Masataka, Nakazato Yuji, Minamino Tohru
Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan.
Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto-ku, Tokyo, Japan.
Pacing Clin Electrophysiol. 2024 Oct;47(10):1326-1337. doi: 10.1111/pace.15058. Epub 2024 Aug 12.
Successful left atrial posterior wall isolation (LAPWI) using only the cryoballoon (CB) is technically challenging for the treatment of atrial fibrillation (AF). This study aimed to evaluate the efficacy of the cross-over technique, wherein an overlapped ablation is performed by placing the CB from both directions in contact with the LAPW.
This was a single-center, retrospective, observational study of 194 consecutive patients with persistent atrial fibrillation (PerAF) who underwent a first-time procedure of pulmonary vein isolation (PVI) + PWI (108 patients) or PVI-only (86 patients) using the CB. The cross-over technique was applied in all LAPWI.
For ablation of the LA roof and bottom, respectively, a mean of 8.6 ± 1.0 (right to left [R→L] 4.3 ± 1.1 and left to right [L→R] 4.3 ± 1.1) and 9.1 ± 1.2 (R→L 4.6 ± 1.6 and L→R 4.5 ± 1.2) CB applications were delivered. LAPW was successfully isolated solely using the CB in 99.1% of patients. Although the PVI + PWI group had significantly longer procedure time, no severe adverse events were observed in either group. During a median follow-up of 19 months, freedom from recurrence of all atrial tachyarrhythmias was achieved in 93.5% of the PVI + PWI group and 72.9% of the PVI-only group (p = .011).
LAPWI performed solely with the CB using the cross-over technique is feasibly, safe, and was independently associated with a significantly higher freedom from recurrence of atrial tachyarrhythmias compared with PVI alone in patients with PerAF.
仅使用冷冻球囊（CB）成功进行左心房后壁隔离（LAPWI）在房颤（AF）治疗中具有技术挑战性。本研究旨在评估交叉技术的疗效，该技术通过从两个方向放置CB与左心房后壁接触进行重叠消融。
这是一项单中心、回顾性、观察性研究，纳入194例连续的持续性房颤（PerAF）患者，他们首次接受了使用CB进行的肺静脉隔离（PVI）+后壁隔离（PWI）（108例患者）或仅PVI（86例患者）手术。所有LAPWI均应用交叉技术。
分别在消融左心房顶部和底部时，平均进行了8.6±1.0次（从右到左[R→L]4.3±1.1次和从左到右[L→R]4.3±1.1次）和9.1±1.2次（R→L 4.6±1.6次和L→R 4.5±1.2次）CB应用。99.1%的患者仅使用CB成功隔离了左心房后壁。虽然PVI+PWI组的手术时间明显更长，但两组均未观察到严重不良事件。在中位随访19个月期间，PVI+PWI组93.5%的患者和仅PVI组72.9%的患者实现了所有房性快速性心律失常无复发（p=0.011）。
在PerAF患者中，使用交叉技术仅用CB进行LAPWI是可行、安全的，并且与单独进行PVI相比，独立地与房性快速性心律失常复发率显著降低相关。
