Lee Sung Ho, Moon Suhyeon, Cha Myung-Jin, Lee So-Ryoung, Kim Ju Youn, Kwon Chang Hee, Shim Jaemin, Park Junbeom, Kim Ki-Hun, Yang Pil-Sung, Kim Jun-Hyung, Oh Il-Young, Lim Hong Euy
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Cardiovasc Electrophysiol. 2025 Jan;36(1):246-255. doi: 10.1111/jce.16508. Epub 2024 Nov 25.
Pulmonary vein isolation (PVI) by cryoballoon ablation (CBA) is considered an effective primary strategy for early persistent atrial fibrillation (AF). However, data regarding CBA for long-standing persistent AF (PeAF) are limited. We evaluated the efficacy and safety of CBA for long-standing PeAF compared to PeAF.
The study included 1484 patients with non-paroxysmal AF from Korean CBA registry data with follow-up of > 12 months after de novo CBA. The primary outcome was recurrence of atrial tachyarrhythmias (ATs) of ≥ 30-s after a 3-month blanking period.
A total of 367 PeAF (25%) and 1117 long-standing PeAF (75.3%) patients (mean age 61.9 ± 9.6 years, 80% men) underwent de novo CBA. Compared to patients with PeAF, patients with long-standing PeAF had more heart failure, previous stroke or transient ischemic attack, chronic kidney disease, higher CHADS-VASc score, and larger left atrium (LA). During a mean follow-up period of 15.1 ± 10.9 months, ATs recurrence occurred in 41.4% of PeAF and 40.1% of long-standing PeAF. Multivariate analysis showed that female gender (hazard ratio [HR]: 1.31, p = 0.01), larger LA ≥ 45 mm (HR: 1.53, p < .001) and LA volume index ≥ 51 mL/m (HR: 1.77, p < 0.001), and longer AF duration ≥ 5 years (HR: 1. 33, p = .003) were associated with ATs recurrence. After propensity score matching, larger LA was an independent factor for ATs recurrence.
During a long-term follow-up period after index CBA in patients with non-paroxysmal AF, ATs recurrence rate was similar between PeAF and long-standing PeAF. CBA might be an effective strategy as an initial rhythm control therapy regardless of AF type.
冷冻球囊消融术（CBA）进行肺静脉隔离（PVI）被认为是早期持续性房颤（AF）的一种有效初始策略。然而，关于CBA治疗长期持续性房颤（PeAF）的数据有限。我们评估了CBA治疗长期PeAF与持续性房颤相比的疗效和安全性。
该研究纳入了1484例来自韩国CBA登记数据的非阵发性房颤患者，在初次CBA后随访超过12个月。主要结局是在3个月空白期后出现持续时间≥30秒的房性快速心律失常（ATs）复发。
共有367例持续性房颤（25%）和1117例长期持续性房颤（75.3%）患者（平均年龄61.9±9.6岁，80%为男性）接受了初次CBA。与持续性房颤患者相比，长期持续性房颤患者有更多心力衰竭、既往卒中或短暂性脑缺血发作、慢性肾病、更高的CHADS-VASc评分以及更大的左心房（LA）。在平均15.1±10.9个月的随访期内，41.4%的持续性房颤患者和40.1%的长期持续性房颤患者出现了ATs复发。多因素分析显示，女性（风险比[HR]：1.31，p = 0.）、LA≥45mm（HR：1.53，p <.001）和LA容积指数≥51mL/m（HR：1.77，p < 0.001）以及房颤持续时间≥5年（HR：1.33，p =.003）与ATs复发相关。在倾向评分匹配后，更大的LA是ATs复发的独立因素。
在非阵发性房颤患者初次CBA后的长期随访期间，持续性房颤和长期持续性房颤的ATs复发率相似。无论房颤类型如何，CBA可能是一种有效的初始节律控制治疗策略。
