Efficacy and safety of pulmonary veins isolation by cryoablation for the treatment of paroxysmal and persistent atrial fibrillation
Efficacy and safety of pulmonary veins isolation by cryoablation for the treatment of paroxysmal and persistent atrial fibrillation
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DOI：
10.1093/europace/eur036
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发表时间：
2011-06-01
期刊：
影响因子：
6.1
通讯作者：
Jacon, Peggy
中科院分区：
文献类型：
--
作者：
Defaye, Pascal;Kane, Adama;Jacon, Peggy
目的观察冷冻导管隔离肺静脉的有效性和安全性。方法和结果117例阵发性房颤(n=92)和持续性房颤(n=25)患者，使用低温导管隔离肺静脉442pv。他们在我们的门诊每3个月进行一次跟踪，如果他们报告了症状，可以更早地进行跟踪。随访3个月时记录48h动态心电图。我们分析了近期和长期的程序和临床结果。我们用一次低温冷冻分离了442个PV中的385个(87%)。在19名患者(16%)中，使用冲洗尖端射频(RF)导管来补充局灶性病变。每个程序(范围6-12)的中位数为9个应用程序。平均手术时间为155±43分钟(75~275分钟)，平均透视曝光时间为35±15分钟(12~73分钟)。手术结束时，103例(88%)患者处于窦性心律。在中位时间9.6个月(范围3-12)内，11名患者失去了随访。分别在随访3、6、9和12个月时，79、79、79和69%的阵发性房颤患者保持无复发状态，而持续性房颤患者的这一比例分别为83、73、59和45%。结论应用冷冻导管行肺静脉隔离术，手术成功率高，远期成功率高，并发症发生率低。必要时辅以焦点射频，冷刀消融是一种安全有效的替代周围式射频消融的方法。
Aims We examined the efficacy and safety of pulmonary vein (PV) isolation, using a cryoballoon catheter.Methods and results We studied 117 consecutive patients presenting with paroxysmal (n = 92) or persistent (n = 25) atrial fibrillation (AF), who underwent attempts at isolation of 442 PV with a cryoballoon catheter. They were followed in our ambulatory department for every 3 months, or earlier if they reported symptoms. A 48 h ambulatory electrocardiogram was recorded at the 3-month visit. We analysed the immediate and long-term procedural and clinical outcomes. We isolated 385 of 442 PV (87%) with a single cryoballoon application. In 19 patients (16%), an irrigated-tip radiofrequency (RF) catheter was used to create a supplemental focal lesion. A median of nine applications per procedure (range 6-12) was delivered. The mean, overall procedural duration was 155 +/- 43 min (range 75-275), and mean duration of fluoroscopic exposure was 35 +/- 15 min (range 12-73). At the end of the procedure, 103 patients (88%) were in sinus rhythm. Over a median period of 9.6 months (range 3-12), 11 patients were lost to follow-up. At 3, 6, 9, and 12 months of follow-up, respectively, 79, 79, 79, and 69% of patients presenting with paroxysmal AF had remained recurrence free, vs. 83, 73, 59, and 45% of patients, respectively, with persistent AF. Phrenic nerve palsy was the most frequent, although reversible complication.Conclusions Pulmonary vein isolation, using a cryoballoon catheter, was completed with a high rate of procedural and long-term success and low rate of minor complications. Supplemented, when needed, by focal RF, cryoballoon ablation was a safe and an effective alternative to a circumferential RF procedure.