阵发性心房颤动射频消融与冷冻球囊消融术后P波参数变化的比较：一项观察性队列研究。

Comparison of P-wave parameter changes after radiofrequency ablation and cryoballoon ablation for paroxysmal atrial fibrillation: An observational cohort study.

作者信息

Antoun Ibrahim, Li Xin, Vali Zakkariya, Abdelrazik Ahmed, Somani Riyaz, Ng G André

机构信息

Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK; Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK.

Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK; Department of Engineering, University of Leicester, Leicester, UK.

出版信息

J Electrocardiol. 2025 Mar-Apr;89:153863. doi: 10.1016/j.jelectrocard.2024.153863. Epub 2025 Jan 4.

DOI:10.1016/j.jelectrocard.2024.153863

PMID:39778362

Abstract

BACKGROUND

Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) can be performed using one-shot cryoballoon ablation (cryo) or point-by-point radiofrequency ablation (RF). This study compares the changes in P-wave parameters between both ablation methods.

METHODS

This single-centre retrospective study included contact force RF and second-generation cryo for PAF between 2018 and 2019. Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12‑leads ECGs with 1-50 hertz bandpass filters were monitored directly during the procedure. Corrected P-wave duration (PWDc), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured and compared between RF and cryo. Additional ablations outside pulmonary veins were excluded.

RESULTS

The final analysis included 226 patients, and the freedom of AF rate was similar at the 12-month follow-up between RF and cryo (76 % vs 74 %, P = 0.12). PWDc and PWV increased and decreased, respectively in both arms. PTFV1 decreased in RF (-3.3 mm.s to -4.6 mm.s, P < 0.001) and cryo (-3.4 mm.s to -5.3 mm.s,P = 0.002). There were similar changes after RF and cryo in PWDc (F = 0.80, P = 0.85), PWV (F = 0.19,P = 0.06), and PWDisp (F = 0.16,P = 0.34) and PTFV1 (P = 0.39). Increased PWDc was correlated with failure of RF (hazard ratio [2.3], 95 % confidence interval [CI]: 1.4-5.9, p = 0.01) and cryo (HR: 2.1, 95 % CI (1.3-4.6), p = 0.02). Results were similar when patients on antiarrhythmic drugs were excluded.

CONCLUSION

RF and cryo caused similar freedom of AF rate at 12 months in PAF and similar P-wave parameter changes.

摘要

背景

阵发性心房颤动（PAF）的肺静脉隔离（PVI）可通过一次性冷冻球囊消融（冷冻）或逐点射频消融（RF）来进行。本研究比较了两种消融方法之间P波参数的变化。

方法

这项单中心回顾性研究纳入了2018年至2019年间接受接触力射频和第二代冷冻治疗PAF的患者。手术成功定义为术后12个月心电图记录无房颤。术中直接监测带1 - 50赫兹带通滤波器的数字12导联心电图。测量并比较了射频和冷冻组的校正P波时限（PWDc）、P波电压（PWV）、P波离散度（PWDisp）和V1导联的P波终末电势（PTFV1）。排除肺静脉外的额外消融。

结果

最终分析纳入226例患者，射频和冷冻组在12个月随访时的无房颤率相似（76%对74%，P = 0.12）。两组的PWDc均升高，PWV均降低。射频组（从 - 3.3 mm·s降至 - 4.6 mm·s，P < 0.001）和冷冻组（从 - 3.4 mm·s降至 - 5.3 mm·s，P = 0.002）的PTFV1均降低。射频和冷冻后PWDc（F = 0.80，P = 0.85）、PWV（F = 0.19，P = 0.06）、PWDisp（F = 0.16，P = 0.34）和PTFV1（P = 0.39）的变化相似。PWDc升高与射频（风险比[2.3]，95%置信区间[CI]：1.4 - 5.9，p = 0.01）和冷冻（HR：2.1，95%CI（1.3 - 4.6），p = 0.02）失败相关。排除使用抗心律失常药物的患者后结果相似。