Hayashi Yusuke, Igarashi Miyako, Yamasaki Hiro, Iioka Yuto, Kino Tabito, Hanaki Yuichi, Kimata Akira, Ogawa Kojiro, Komatsu Yuki, Ishizu Tomoko
Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Int J Cardiol. 2025 Jun 15;429:133177. doi: 10.1016/j.ijcard.2025.133177. Epub 2025 Mar 18.
Left atrial calcification (LAC) following atrial fibrillation (AF) ablation is associated with major adverse cardiovascular events, with prior reports focusing on radiofrequency catheter ablation (RFCA) rather than cryoballoon ablation (CBA). The aim of this study was to investigate the frequency of LAC and stiff LA physiology (SLAP) in patients undergoing CBA as the initial therapy for AF, compared with those undergoing RFCA, using a propensity score-matched (PSM) population.
We conducted a retrospective cohort study involving 2680 consecutive patients who underwent AF ablation with RFCA or CBA. Patients with rheumatic valve disease or mitral valve replacement, those undergoing dialysis, and those without postoperative computed tomography (CT) imaging were excluded. CT images acquired ≥1 year after the initial procedure were used to evaluate the LAC.
In total, 473 eligible patients were identified. PSM created 125 pairs. After a median follow-up of 4.7 years, 9 (4 %) of 250 patients presented with LAC. Those who underwent CBA had a significantly lower incidence of LAC and SLAP compared to those who underwent RFCA (LAC: 1 % vs. 6 %, P = 0.03; SLAP: 1 % vs. 9 %, P = 0.005). Right ventricular systolic pressure significantly increased in the RFCA group (pre-ablation: 23 ± 8 vs. post-ablation: 26 ± 8, P = 0.01), but remained unchanged in the CBA group (pre-ablation: 23 ± 7 vs. post-ablation: 23 ± 8, P = 0.88).
The use of CBA as the initial ablation seems to have clinical benefits in preventing LAC and SLAP compared to RFCA.
房颤消融术后左心房钙化（LAC）与主要不良心血管事件相关，先前的报告主要关注射频导管消融（RFCA）而非冷冻球囊消融（CBA）。本研究的目的是使用倾向评分匹配（PSM）人群，比较接受CBA作为房颤初始治疗的患者与接受RFCA的患者中LAC和僵硬左心房生理（SLAP）的发生率。
我们进行了一项回顾性队列研究，纳入了2680例连续接受RFCA或CBA房颤消融的患者。排除患有风湿性瓣膜病或二尖瓣置换术的患者、接受透析的患者以及术后未进行计算机断层扫描（CT）成像的患者。初次手术后≥1年获得的CT图像用于评估LAC。
总共确定了473例符合条件的患者。PSM创建了125对。中位随访4.7年后，250例患者中有9例（4%）出现LAC。与接受RFCA的患者相比，接受CBA的患者LAC和SLAP的发生率显著更低（LAC：1%对6%，P = 0.03；SLAP：1%对9%，P = 0.005）。RFCA组右心室收缩压显著升高（消融前：23±8对消融后：26±8，P = 0.01），而CBA组保持不变（消融前：23±7对消融后：23±8，P = 0.88）。
与RFCA相比，使用CBA作为初始消融似乎在预防LAC和SLAP方面具有临床益处。
