Kanaoka Koshiro, Miyamoto Koji, Iwanaga Yoshitaka, Nakai Michikazu, Tonegawa-Kuji Reina, Sumita Yoko, Inoue Koichi, Yamane Teiichi, Nogami Akihiko, Miyamoto Yoshihiro, Shimizu Wataru, Kusano Kengo
Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
Heart Rhythm O2. 2025 Jan 28;6(4):410-416. doi: 10.1016/j.hroo.2025.01.009. eCollection 2025 Apr.
Balloon ablation for pulmonary vein isolation (PVI) is a well-established treatment option for atrial fibrillation. Although some patients require touch-up ablation, generalizable evidence is limited.
This study aimed to investigate the current status and outcomes of touch-up applications using a nationwide registry in Japan.
Patients ≥18 years of age who underwent first-time PVI between January 2017 and December 2020 were included using the data from the Japanese Catheter Ablation registry. The annual trends in the proportion of cases requiring touch-up ablation with radiofrequency ablation were determined, and the associations of ablation strategies with acute success and periprocedural complications were analyzed using logistic regression analysis.
Of the 51,402 patients included, 28,412 and 22,990 patients underwent PVI using radiofrequency ablation and balloon ablation, respectively. In the balloon ablation group, 1462 (6.4%) patients required touch-up applications, and the proportion of cases requiring touch-up applications decreased during the study period from 9.5% in 2017 to 5.5% in 2020 ( for trend < .001). The proportion of acute success was >99% across all ablation strategies. Although 2.5% of the patients in the touch-up ablation group had phrenic nerve palsy, the composite of complications, except for phrenic nerve palsy, was not significantly increased in the balloon + touch-up ablation group compared with that in the balloon ablation-only group and radiofrequency ablation group.
Touch-up applications following balloon ablation are required in some cases. Touch-up ablation with radiofrequency ablation may be a treatment option when achieving successful PVI using balloon ablation is difficult.
球囊消融肺静脉隔离术（PVI）是一种成熟的房颤治疗方法。尽管一些患者需要进行补充消融，但普遍适用的证据有限。
本研究旨在利用日本全国性登记系统调查补充消融应用的现状和结果。
纳入2017年1月至2020年12月期间首次接受PVI的18岁及以上患者，数据来自日本导管消融登记系统。确定需要射频消融补充消融的病例比例的年度趋势，并使用逻辑回归分析分析消融策略与急性成功率和围手术期并发症之间的关联。
在纳入的51402例患者中，分别有28412例和22990例患者接受了射频消融和球囊消融PVI。在球囊消融组中，1462例（6.4%）患者需要进行补充消融，在研究期间，需要补充消融的病例比例从2017年的9.5%降至2020年的5.5%（趋势P<0.001）。所有消融策略的急性成功率均>99%。尽管补充消融组中有2.5%的患者出现膈神经麻痹，但与单纯球囊消融组和射频消融组相比，球囊+补充消融组除膈神经麻痹外的并发症综合发生率并未显著增加。
在某些情况下，球囊消融后需要进行补充消融。当使用球囊消融难以实现成功的PVI时，射频消融补充消融可能是一种治疗选择。
