Tsaroev Bashir, Sharifulin Ravil, Afanasyev Alexander, Khrushchev Sergey, Murtazaliev Murtazali, Lovtsova Darya, Kashapov Robert, Ruzankin Pavel, Mustaev Muslim, Bogachev-Prokophiev Alexander
Department of Adult Cardiac Surgery, E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia.
Laboratory of Applied Inverse Problems, Sobolev Institute of Mathematics, Novosibirsk, Russia.
Front Cardiovasc Med. 2024 Sep 18;11:1448523. doi: 10.3389/fcvm.2024.1448523. eCollection 2024.
Surgical ablation of atrial fibrillation has been the most efficient treatment for atrial fibrillation (AF). Combined energy (CE) ablation and cryoablation alone (CA) are the most common energy modes used for ablation, however, comparative data is lacking.
To compare the efficacy of CE ablation with CA in the setting of concomitant biatrial ablation for non-paroxysmal AF.
A retrospective analysis of 453 patients with non-paroxysmal AF undergone concomitant biatrial ablation from November 2007 to December 2022 during elective cardiac surgery using either combined bipolar radiofrequency with cryoenergy or cryoenergy alone was performed. Propensity score matching was conducted to balance the covariates in the groups.
There were 157 patients per group after matching. CE ablation was associated with lower odds of atrial tachyarrhythmia recurrence (OR = 0.13, 95% CI 0.02-0.91, = 0.040), a significantly lower rate of hospital readmissions due to rhythm disruption (HR = 0.34, 95% CI 0.18-0.65, < 0.001), and lower cumulative incidence of stroke (SHR = 0.38, 95% CI 0.15-0.97, = 0.043). No significant difference in permanent pacemaker implantation was observed between the two groups.
In the setting of concomitant biatrial ablation for non-paroxysmal AF, combined bipolar radiofrequency and cryoablation appear to be a superior treatment modality compared to cryoablation alone in achieving long-term freedom from atrial arrhythmias, in reducing arrhythmia-related hospital readmissions and ischemic strokes.
外科消融术一直是治疗心房颤动（AF）最有效的方法。联合能量（CE）消融和单纯冷冻消融（CA）是消融最常用的能量模式，然而，缺乏比较数据。
比较CE消融与CA在非阵发性AF同期双房消融中的疗效。
对2007年11月至2022年12月期间在择期心脏手术中采用双极射频联合冷冻能量或单纯冷冻能量进行同期双房消融的453例非阵发性AF患者进行回顾性分析。进行倾向评分匹配以平衡各组的协变量。
匹配后每组有157例患者。CE消融与房性快速性心律失常复发几率较低相关（OR = 0.13，95%CI 0.02 - 0.91，P = 0.040），因节律紊乱导致的再入院率显著较低（HR = 0.34，95%CI 0.18 - 0.65，P < 0.001），且卒中累积发生率较低（SHR = 0.38，95%CI 0.15 - 0.97，P = 0.043）。两组在永久起搏器植入方面未观察到显著差异。
在非阵发性AF同期双房消融中，与单纯冷冻消融相比，双极射频联合冷冻消融在实现长期无房性心律失常、减少心律失常相关的再入院率和缺血性卒中方面似乎是一种更优的治疗方式。
