Nomura Ryohei, Hasegawa Kanae, Tsuji Toshihiko, Mukai Moe, Miyoshi Machiko, Tama Naoto, Ikeda Hiroyuki, Ishida Kentaro, Uzui Hiroyasu, Tada Hiroshi
Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Heart Vessels. 2025 Jun 6. doi: 10.1007/s00380-025-02559-x.
Pulmonary vein (PV) isolation by catheter ablation is a widely used curative therapy for atrial fibrillation (AF). However, in patients with persistent AF (PeAF), long-term outcomes are poor when PV isolation is performed alone. Although left atrial (LA) roof ablation is sometimes added to PV isolation, its effectiveness and predictors of success remain unclear. To identify predictors of arrhythmia recurrence in patients with PeAF undergoing LA roof ablation and PV isolation using a cryoballoon catheter. A retrospective assessment of LA roof ablation and PV isolation using a cryoballoon was performed in 65 consecutive patients with PeAF. The median age of the patients was 69 years [Q1:61, Q3:75]; 55% were female, and 49% had longstanding PeAF. The complete LA roof block success rate using a cryoballoon was 92.3%, with no esophagus-related complications. The 1-year post-ablation arrhythmia-free rate was 83.3%. Atrial arrhythmia recurrence was more common within the 3-month blanking period. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reduction rate ≥60.7% and sinus rhythm at 1-month post-ablation, and no arrhythmia during the 3-month blanking period strongly predicted arrhythmia-free status at 1 year post-ablation. In patients with PeAF who underwent LA roof ablation and PV isolation using a cryoballoon, the arrhythmia-free rate was high. The NT-proBNP reduction rate at 1-month post-ablation may serve as a simple and potentially useful predictor of procedural success.
通过导管消融进行肺静脉隔离是一种广泛应用于治疗心房颤动（AF）的疗法。然而，对于持续性房颤（PeAF）患者，单独进行肺静脉隔离的长期效果不佳。尽管有时会在肺静脉隔离的基础上增加左心房（LA）顶部消融，但其有效性和成功的预测因素仍不明确。目的是确定接受LA顶部消融和使用冷冻球囊导管进行肺静脉隔离的PeAF患者心律失常复发的预测因素。对65例连续的PeAF患者进行了回顾性评估，这些患者接受了使用冷冻球囊的LA顶部消融和肺静脉隔离。患者的中位年龄为69岁[第一四分位数（Q1）：61，第三四分位数（Q3）：75]；55%为女性，49%患有长期持续性房颤。使用冷冻球囊实现完全LA顶部阻滞的成功率为92.3%，无食管相关并发症。消融后1年无心律失常发生率为83.3%。房性心律失常复发在3个月的空白期内更为常见。脑钠肽前体N末端（NT-proBNP）降低率≥60.7%、消融后1个月窦性心律以及3个月空白期内无心律失常强烈预测消融后1年无心律失常状态。在接受LA顶部消融和使用冷冻球囊进行肺静脉隔离的PeAF患者中，无心律失常发生率较高。消融后1个月的NT-proBNP降低率可能是手术成功的一个简单且潜在有用的预测指标。
