Characteristics of the nonpulmonary vein foci induced after second-generation cryoballoon ablation for paroxysmal atrial fibrillation
Characteristics of the nonpulmonary vein foci induced after second-generation cryoballoon ablation for paroxysmal atrial fibrillation
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DOI：
10.1111/jce.14314
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发表时间：
2019-12-16
影响因子：
2.7
通讯作者：
Sasano, Tetuo
中科院分区：
文献类型：
--
作者：
Kato, Nobutaka;Nitta, Junichi;Sasano, Tetuo
引言使用冷冻球囊进行肺静脉隔离（PVI）对阵发性房颤（PAF）患者有效;然而，很少有报道评估冷冻球囊消融后的非肺静脉（PV）病灶。我们的目的是评价非肺静脉病灶的特征和冷冻球囊消融术后房颤（AF）复发的预测因素。方法和结果这是一项单中心回顾性研究，涉及647例使用第二代冷冻球囊进行初始肺静脉隔离的PAF患者。肺静脉隔离后，所有患者均接受大剂量异丙肾上腺素输注，以评估非肺静脉病灶的存在。在211例患者（32.6%）中观察到非PV病灶，最常见于上级腔静脉。较高年龄（比值比[OR] = 1.02; 95%置信区间[CI] = 1.00-1.04; P = .025），女性（OR = 1.65; 95% CI = 1.13-2.41; P = 0.009）和较低的体重指数（OR = 0.95; 95% CI = 0.89-1.00; P = 0.049）与非PV病灶显著相关。非肺静脉病灶的存在是房颤复发的独立预测因素（风险比= 1.70; 95% CI = 1.12-2.60; P = 0.014）。当非肺静脉病灶可标测并成功消融时，非肺静脉病灶患者的结局与无非肺静脉病灶患者相似（1年无房颤生存率为88.5% vs 91.5%; P = 0.338）。相反，当我们未能检测和消除非肺静脉病灶，因为它们有多个起源，并不一致的诱导（多变化的非肺静脉病灶），1年无房颤生存率为56.4%，即使在底物修改。结论1/3的PAF患者冷冻球囊消融后存在非肺静脉病灶，且与AF复发相关。当非肺静脉病灶可标测时，导管消融对非肺静脉病灶有效;然而，多变化的非肺静脉病灶与预后不良相关。
Introduction Pulmonary vein isolation (PVI) using cryoballoon is effective for patients with paroxysmal atrial fibrillation (PAF); however, few reports have evaluated the non-pulmonary vein (PV) foci after cryoballoon ablation. We aimed to evaluate the characteristics of non-PV foci and predictors of atrial fibrillation (AF) recurrence after cryoballoon ablation. Methods and Results This was a single-center retrospective study of 647 patients with PAF who underwent initial PVI using a second-generation cryoballoon. After PVI, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci. Non-PV foci were observed in 211 patients (32.6%), which were most frequently observed in the superior vena cava. Higher age (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.00-1.04; P = .025), female sex (OR = 1.65; 95% CI = 1.13-2.41; P = .009), and lower body mass index (OR = 0.95; 95% CI = 0.89-1.00; P = .049) were significantly associated with non-PV foci. The existence of non-PV foci was an independent predictor of AF recurrence (Hazard's ratio = 1.70; 95% CI = 1.12-2.60; P = .014). When non-PV foci were mappable and successfully ablated, patients with non-PV foci showed similar outcomes with those without non-PV foci (1-year AF-free survival rates of 88.5% vs 91.5%; P = .338). Conversely, when we failed to detect and eliminate non-PV foci because they had multiple origins and were not consistently inducible (multichanging non-PV foci), the 1-year AF-free survival rate was 56.4% even after substrate modification. Conclusion Non-PV foci were observed in one-third of patients with PAF after cryoballoon ablation and were associated with AF recurrence. Catheter ablation for non-PV foci was effective when they were mappable; however, multichanging non-PV foci were associated with worse prognosis.