The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study
The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study
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DOI：
10.1093/eurheartj/ehn570
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发表时间：
2009-03-01
影响因子：
39.3
通讯作者：
Kuck, Karl Heinz
中科院分区：
文献类型：
--
作者：
Chun, Kyoung-Ryul Julian;Schmidt, Boris;Kuck, Karl Heinz
通过球囊导管（Arctic Front，Cryocath™）进行的冷冻热能（CTE）消融是一种用于肺静脉隔离（PVI）的新技术。然而，基于球囊的PVI方法与膈神经麻痹（PNP）相关。我们研究了“单个大冷冻球囊”所形成的CTE损伤是否能够（i）在无左心房（LA）成像的情况下实现急性电生理PVI，以及（ii）在阵发性心房颤动（PAF）患者中避免PNP。
在进行两次房间隔穿刺后，将一根Lasso导管和一根带有可操控鞘管的28mm大冷冻球囊导管插入LA。获取了所有肺静脉的肺静脉造影和肺静脉口Lasso记录。选择性肺静脉造影用于评估球囊与LA - 肺静脉连接处的接触情况。CTE消融持续300秒，在右侧肺静脉冷冻时对膈神经进行起搏。
纳入了27例PAF患者（19例男性，平均年龄：56±9岁，LA大小：42±5mm）（平均病程：6.6±5.7年）。99根肺静脉中的97根（98%）实现了PVI。手术时间、球囊使用时间和透视时间的中位数（Q₁；Q₃）分别为220分钟（190；245）、130分钟（90；170）和50分钟（42；69）。在肺静脉远端消融后出现了3例短暂性PNP。未出现肺静脉狭窄。总随访时间的中位数（Q₁；Q₃）为271天（147；356），27例患者中有19例（70%）在（3个月的空白期后）维持窦性心律。
使用单个大冷冻球囊技术，几乎所有肺静脉（98%）都可以在无LA成像的情况下实现电隔离，并且只要避免在肺静脉间隔内进行远端消融，就可能降低PNP的发生率。
Cryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, Cryocath (TM)) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether 'single big cryoballoon'-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).After double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA-PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 +/- 9 years, LA size: 42 +/- 5 mm) with PAF (mean duration: 6.6 +/- 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q(1); Q(3)) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.