Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success
Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success
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DOI：
10.1093/europace/eut021
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发表时间：
2013-08-01
期刊：
影响因子：
6.1
通讯作者：
Kuniss, Malte
中科院分区：
文献类型：
--
作者：
Neumann, Thomas;Wojcik, Maciej;Kuniss, Malte
心房颤动（AF）冷冻球囊（CB）消融术后的长期疗效尚不清楚。本研究描述了163例阵发性房颤（PAF）患者的5年随访结果和CB消融成功的预测因素。采用CB技术进行肺静脉隔离（PVI）。这项连续单中心研究的主要终点是首次心电图记录的AF复发、房性心动过速或房扑（AFLAT）。单次CB消融后的5年成功率为53。在70例患者中，使用单个28 mm球囊实现了急性完全肺静脉隔离。AFLAT复发的单变量预测因子为（1）左心房大小，标准化左心房（NLA）为10.25 [风险比（HR）为1.81，95置信区间（CI）：1.282.56]与NLA 10.25相比（35 vs. 53，P 0.0001）和（2）肾功能，肾小球滤过率受损（GFR）80 ml/min（HR为1.26，95 CI：1.021.57），与GFR 80 ml/min相比（45 vs. 53，P 0.041）。标准化左心房10.25是结局的唯一独立预测因子（HR 2.11; 95 CI：1.343.31; P 0.0001）。即使在使用CB消融术进行环周肺静脉隔离后5年，大部分PAF患者仍可以维持窦性心律。首次手术后前12个月内无AFLAT的下降率最高。左房增大和/或肾功能损害的患者预后较差。
Long-term efficacy following cryoballoon (CB) ablation of atrial fibrillation (AF) remains unknown. This study describes 5 years follow-up results and predictors of success of CB ablation in patients with paroxysmal atrial fibrillation (PAF).In total, 163 patients were enrolled with symptomatic, drug refractory PAF. Pulmonary vein isolation (PVI) with CB technique was performed. Primary endpoint of this consecutive single-centre study was first electrocardiogram-documented recurrence of AF, atrial tachycardia or atrial flutter (AFLAT). Five years success rate after single CB ablation was 53. In 70 of the patients acute complete PVI was achieved with a single 28 mm balloon. The univariate predictors of AFLAT recurrence were (1) size of left atrium, with normalized left atrium (NLA) 10.25 [hazard ratios (HR) of 1.81, 95 confidence interval (CI): 1.282.56] when compared with NLA 10.25 (35 vs. 53, P 0.0001) and (2) renal function, with impaired glomerular filtration rate (GFR) 80 ml/min (HR of 1.26, 95 CI: 1.021.57) when compared with GFR 80 ml/min (45 vs. 53, P 0.041). Normalized left atrium 10.25 was the sole independent predictor for outcome (HR 2.11; 95 CI: 1.343.31; P 0.0001).Sinus rhythm can be maintained in a substantial proportion of patients with PAF even 5 years after circumferential PVI using CB ablation. The rate of decline in freedom from AFLAT was highest within the first 12 months after the index procedure. The patients with enlarged left atrium and/or impaired renal function have lower outcome.